HomeMy WebLinkAboutChurch & McDougal St - Engineering
_ _l ___ ____________
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date ~'~ / 7 '- 05
Time II.' CO
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES
Inspected Date <t>-l~ -05" Time II ~'O 0 -A:- By
Remarks t/!..elJl()l/r<.'(Q 3!q'''5cl/,'lce /~J/e kl)~tl f5:!:l(,
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RESTORATION REQUIRED
YES
NO ">'---
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel
D Repaired by City
o Repaired by Permittee
o No Damage Found
D Asphalt D PCC 0 Other
Work Order # 3033<]- .21 I
~COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)