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22522 73RD PL W
APPLICATION
for
The City of Edmonds SIDE SEWER PERMT
OUTSIDE r-1 INSIDE REPAIRS E]
7D
CARDNo . ......................................
EASEMENT No . ......................................
410 10Y
OWNER ......... le ......... ......
....... ... .... CONTRACTOR ........
Vt�L ........... PERMIT No.
.... .... .... ..... ......
. ..... STREET
HOUSENo . ....... ................. ............................ 4q, ........... AVENUE LOT -No . ...................................................................... BLOCK No . ...............................................
NA4EADD . ........ ............... .................................................
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APPROVED
si FE rp 11 u 1963
Date Approved:
BACKFILL WORK ORDER ISSUED...... ............................. DEPOSIT, $ .............................................
SEWER WORK ORDER ISSUED .......................................... D A T E BY .............
... ...... . . ......... ... ... ............. ............ ............