122 MAIN ST.PDF122 MAIN ST
APPLICATION
The City of Edmonds for
SIDE SEWER PERMIT
OUTSIDE Rr INSIDE [j REPAIRS 0
CARD No . .......................................
EASEMENT No . ............
..............
OWNER ... ......... ....................
................. . CONTRACTOR
L L PERAUT No.
........
....................
.........
HOUSE No'_-1 ... ......... ...........................
STREET
......... AVEN .... ........
AVENUE LOT No.
4 ..... /� .........................................
BLOCK No. ..............
NAME ADD.
•
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... ........... ................
..A
APPROVED
Ml 2'2j
Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT,. $ ---------------------------------------------
SEWER. WORK ORDER ISSUED .......................................... DATE ... / .................. BY