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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date 11- N ~ 0 <)
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Time
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Received by /1l1fl<2 <' '(phone. person)
Location of Work to be inspected L;"lCO ~ <::i- {),c:",s
Name of person requesting inspection PeVl h ,;" ,c--,
Address of person requesting inspection C'.vr,(J ,ti ,,1l. I 7 <i-.E
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Type of Inspection (circle appropriate one):
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Phone No, 4-17 -l(8ifCj
Sewer Foundation Framing Chimney Plumbing Final
Permit No.---
Sewer Excav. ~"'---te ~
INSPECTION NOTES:
Inspected: Date 11- I '-f - 0 5
Remarks: K2~()(...,re..J 2-" L.I.
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Time &: 2-0 flf</\. By
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RESTORATION REQUIRED . . . . .. YES rx. NO
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SURFACE RESTORATION: {x"E;' :
SURFACE TYPE: 0 Unimproved DGravel ~sPhalt 0 PCC 0 Other
o Repaired by City Work Order # 3034Z-{)5"Z- ~
o Repaired by Permittee M COMPLETE 3LJ I G "3 -[
o No Damage Found 0 INCOMPLETE
,r.:nntinIIA,nnrAVArSA side ifnecessarv)
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