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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date 03- 2-?- - 0 \
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,.- "
.,
Time
Received by O~ '--::. (phone. person)
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Location of Work to be inspected KiI V
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
~oundation Framing Chimney Plumbing Final
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INSPECTION NOTES:
Inspected: Date 03 -2 2. --0 I Time
Remarks: 1)l'>Y\'+- l< 0"\ Ow q)(.c:u~'+ (\ON~l:~ bf :;.e~
Phone No.
Permit No.
S_ewer Excav. Other uJDo*" l & DIo
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved ~Gravel o Asphalt OPCC
o Other
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o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)