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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date (,.? J-o)
Time
/ ~ vi> .11h. Received by
7/7
IPhone,S
Location of Work to be inspected Lf 0) , )' i) I- ~;-
Name of person requesting inspection L-J ""T (I r p,"./
Address of person requesting inspection /]() I ,) <> l?
Type of Inspection Icircle appropriate one):
Sewer Foundation Framing Chimney Plumbing Final
Phone No. 'I1l- C/~c/(l
Permit No.
Sewer Excav. @c...JtZ. T e r
Inspected: Date
Remarks:
INSPECTION NOTES:
b}.J-c:'S-
Time 1": <IV ,fIn By 7/7
. .I ..e.,k a r c/~dv~
,.}.." TII/tt:.i ~ X Give c-'0c)/J/.e.r c Fucf~ I
. ,- ~
RESTORATION REQUiRED...... YES Y NO
/ ~"\' /
~'
q 11- fJ
). ~ e-I ~
-
,
H
I, >J
'""i ~
'-.\ ~
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved o Gravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
o Asphalt OPCC )QOtherTof- 5.0,/
Work Order # 50"3'/).. -031
o COMPLETE
P(INCOMPLETE
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