HomeMy WebLinkAbout122 W 5th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date /2 - (7 -05
Time
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Received by f)C"1. h. IS L, ~hone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection C 01 f 'rh. ,,"cd 17 ..f- /3 Phone No q 17 ~ <IgL( '1
Type of Inspection (circle appropriate one) Permit No '"
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Othe(/UJ-~--f~r 'J
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INSPECTION NOTES
Inspected Date !z -/1 -o?'
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Remarks e p% , v- 2 c
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Time
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RESTORATION REQUIRED
YES k NO )<
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
D Asphalt D PCC D Other
Work Order # 363L/1. -()~
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)