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21426 89TH AVE W
APPLICATION CARD No . ......................................
for
The City of Edmonds STREff FILE SIDE SEWER PERYaT EASEMENT No . ......................................
YOUTSIDE INSIDE E] REPAIRS Fl
26/— 0 0 ('/60
OWNER .............. 2Jk?&.4: ----------- ��L! ... .................................................. CONTRACTOR ......... /Y ......... .................... PERMIT No.
STREET
HOUSENo. ..... - -------- 1'-5e17'1 ....... ....... . AVENUE LOT No . ...................................................................... BLOCK No . .....................................
/'/.S 4 - sp;",/ 'Ove. NAME ADD . ............ &Akl,�& ....... ............................. ge ..................................................................
9
Date
BACKPILL WORK ORDER ISSUED ....................
SEWER WORK ORDER ISSUED ..............
Approved:
DEPOSIT, $ .............................................
... DATE .....
.............................. BY ...
NOTICE:
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a
W.
F-Fa nt.
-N'.o ... warran Y
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds,; its Employees and Consultants.
Th,.e City of �Edrn.onds does. not. warrant the
n these
accuracy of anything set forth o
rn a P ('�). A n . y person or entity -requesting a
copy should conduct an independent
inquiry regarding th*e inform'ation shown on
i
_tFe -map(s)/ including, but not i'mited to,
the lociation of any sew-er stub shown. Suc
sewer stubs may or may* not e.xist. and may
or may not exist at the location shown
Neither the City of Edmonds nor its r the
empl-o-yee-s o-r offi-ce-rs -shal-1 be 1--ia-b-1--e fo
information given' on this map(5), nor for
e representation provided based
any on
upon said map(s).