22414 72ND PL W.PDFlill 11111111
5723
22414 72ND PL W
APPLICATION
for
The City of Edmonds SIDE SEWER PERYaT
OUTSIDE E] INSIDE E] REPAIRS C]
0 4 D jif To X,4
OWNER..................................................................... - ---------------------------------------------- CONTRACTOR ......................................................................
HOUSE No . ....... 7 2- Xl�d- STREET
yt
..................................................................... ------------ AVENUE LOT No . ............................................................
NAMEADD . .........................................................................
j .7 -)- (
V
Date
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT,
SEWER WORK ORDER ISSUED ..........................................
CARDNo . ......................................
EASEMENT No . ......................................
............................. PERMIT No. �-U- -e
........ BLOCK No . ...............................................
..................................... ...............................................
Z5
ce
Approved:
DAVk,o .... V .... ........ B.V ... 0