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22509 73RD PL W
APPLICATION CARD No . ........................................
for
The City of Edmonds SEDE SEWER PERYaT
OUTSIDE E] INSIDE 0 REPAIRS E] EASEMENT.No . ......................................
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................. AVENUE LOT No - ------ ........................
NAME ADD . ..........................................
......... 1--.- BLOCK No . .......................
�PPROVED
UL 8 IN3
Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .............................................
SEWER WORK ORDER ISSUED .......................................... DATE F-0 ............. By ... ...... ... ..... .... ... .......... ........
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