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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST:
Date Cj -1..-5 -0 'S
Time
8:6 Am
Received by fJe'l'l,j E
(phone, person)
Location of Work to be inspected (;, 2.:z.. So, F'r....V\.c.;-:,
Name of person requesting inspection /).e rt VI " s E .
Address of person requesting inspection ur f }{ r J (t <I-- [)
Type of Inspection (circle appropriate one):
Phone No. <'/11.. cf &'<.(<j
Sewer Foundation Framing Chimney Plumbing Final
Permit No.
Sewer Excav. Othee::..w"-./+.e3
INSPECTION NOTES:
Inspected: Date cr. '-5' -0<)
Remarks: e. Itcl'-~ bro /<..e "'-
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tt -sLeclulL 80 (Jt\.,+ '
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RESTORATION REQUIRED . . . . .. YES
NO )>(
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC 0 Other
Work Order #-'3034L- O<{(.,
o COMPLETE
o INCOMPLETE
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