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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . INSPECTION REPORT. . . . . . . .
REQUEST:
Date If -~.~ 0:; S\.Nd"-'1 Time 3 fl/v1.
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Received by !J ewr I".;, E
(phone. person)
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Location of Work to be inspected lJlud b~'J a..-<..d C{-a.Se .5,.-. tJ. "J. LorVl..€ r
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Name of person requesting inspection Vt'.~ V\ IS c..
Address of person requesting inspection c...o,/"i) Yti-rJJ II <t- 6 Phone No. '-I n -'f8<j 4
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Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing' Final Sewer Excav. Other vJ6...-t~ ,
INSPECTION NOTES:
Inspected: Date /1- (., - 05
Remarks: Rp .0,:,.,0, Z" P V L
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Time 5 j7 f'V/
fvu,in brok.e.,
By Oe"",5 E-.
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RESTORATION REQUIRED . . . . .. YES '>L NO
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- LJk.\J6ef Ave.. v
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SURFACE RESTORATION: ly...'L
SURFACE TYPE: o Unimproved OGravel .21 Asphalt OPCC o Other
o Repaired by City Work Order # '3034 '2..- 050 ~-
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o Repaired by Permittee
o No Damage Found
r>.a COMPLETE €,K 34 (,,3
o INCOMPLETE
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