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21323 95TH AVE W
APPLICATION
for
The City of Edmonds SIODE SEWER FERNaT
NEW CONSTRUCTION 0 REPAIRS 0 EASEMENT No . ..........................................
111-06700
OWNER ........... Jolin 11. Hoffman
--------------------------------------------------------------------------------------------------- CONTRACTOR ............... .................................................................................. PERMIT No . ......................
ADDRESS ....... 21.3.2.3-:n --- 9.5.th ... Ave ...... ,I ................................................
F- I
L
0
LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAMEOF ADDITION ................................................................................................
Dye Tested On Sawer 1972
Approved:
DATE................................................ By ......................................................................