21522 90TH AVE W.PDFlill 11111111
8775
21522 90TH AVE W
APPLICATION
ror
The City of Edmonds SIDE SEWER PERMIT
EASEMENT No . ..........................................
REPAIRS E]
I I I -F3900
OW`NM ........... Robe.r.t ... D ...... L.Oa-r29 .................................. .................... CONTRACTOR .................................................................
......... .. .. .................... ------------ PERMIT No . ........... ..........
ADDRESS ------ ... 9Q.th..AYe....W . ............................................... LEGAL DESCRIPTION: LOT No . .............................................. BLOCK No . ............................................
NAMEOF ADDITION ..................................................................................................................
0
Dye Tested On Sewer 1972
Approved:
DATE................................................ By ......................................................................