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21707 88TH AVE W
APPLICATION
for
The City of Edmonds 811DE SEVVER FERMT
ck OUTSIDE INSIDE E] REPAIRS E]
V
OWNER..................... .................................................................... CONTRACTOR .........................................
STREET
HOUSE No.(62.�.3 .......... /4� . .......... ----- 5?) --------------------------------------- -.. AVENUE LOT No.
02 / 710 7 — 466 7-w e4 r4e . tj. NAME ADD . ............................................
w
Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .............................................
SEWER WORK ORDER ISSUED .......................................... DATE .....
CARD No . ......................................
EASEMENT No . .............................
--------------------------------------------------- PERMIT No
.............................. BLOCK No . ...............................................
................. BY ---
a
NOTICE:
No a r-ra n - y .. of n the a*ttached
The information shown o
map(s) was cOm,piled for use by the GtY Of
Edmonds.; its Employees and Consultants.
Th,.e City of 'Edmonds does. not. warrant the
et forth on these
accuracy of anything s
Map(s�. An . y person or entity,requesting a
copy should onduct an independent
e info'rm'ati(Dn shown on
inquiry regarding th
tF� -map(s)., including, but not limited to, -1-
the lociation of any sew-er stub shown. Suc
sewer stubs may or may- not exist. and may
at the location shown
or may not exist
Neither the City of Edmonds nor its
empl-oyee-s o*r office-rs -shall be 1--ia-b-1--e for the
information given* on this map(s), nor for
any one representation provided based
upon said. map(s),