HomeMy WebLinkAbout1015 W Hwy 101 - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . . .
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REQUEST
Date 10.... 2- ~- Oc.(
Time
~ 711/M..
Received by PC:-t.t v< {S E.~ (phone, person)
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Location of Work to be inspected (6 (S- ({t ~~v (0 ( tJ
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Name of person requesting inspection !/-61.VI... (~ t;:
Address of person requesting inspection ~r;t? Yc.ur-ci (7 ~g Phone No 1- (7 .... ~ gtf'1
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other tU~+<:. r
INSPECTION NOTES
Inspected Date 10 - L g - 0 L( Time S P bv'- By De V\ V'\ l '5 E-
Remarks IJlIS 5erv(ce.- o..vtd ViA...e+er O'''''':YO.iAC{Uy ~ .wa..'5 fOG."\.+-~d at
--ri-..e. 5~tJ Lur i'Le r 0 '-'-eft s+ cx+ ~~ GI-eYlLJood TN.. /M..I2fev W"'S
VlA-DJLd T-D +k Fovvt.-t~,V\ Sf-. /~CA..ti-O",,- due. +0 +k. V\.ew hDo<;fer-
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RESTORATION REQUIRED
YES
NO
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
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HWt '0/ /.()
o Asphalt 0 PCC 0 Other
Work Order # (42-7 8--oCo 1
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)