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21225 96TH AVE W
APPLICATION
for
The City of EdmoncW f�'EET FILE SEDE SEWER PERMIT
NEW CONSTRUCTION [] REPAIRS 0 EASEMENT No . ..........................................
110-00300
OWNER............ Alice .. Smitli ....................................................................
21225 - 96th Ave. 14.
ADDRESS..........................................................................................................
CONTRACTOR.................................................................................................. PERMIT No . ......................
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ........... ................................
NAME OF ADDITION .......................................
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................