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22529 73RD PL W
APPLICATION
for
SIDE SEWER PERMIT
The City of Edmonds
OUTSIDE INSIDE PC REPAIRS 0
— /n 7?
OWNER........ ............ ...............
HOUSE No . ..... ...... .. . 0 .."50 ..... ...............
0
CARD No . ..............
EASEMENT No . ............... ..... ... . . ......
�--lo /0�
........................ CONTRACTOR .. ..........
......................... .. ......... 4�.' ........... ............... PERMIT No.
STREET
...... ................. AVENUE LOT No . ....................... 19 .............................. ........... BLOCK No. .................... ............
N E ADD .....
AM .................................... ................... . . ... ..
a
o ca
J: -g
73
/Vu-
/y,
Date Approved:
�-t of
10'a a a4
BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, $ ......................................................
SEWERWORK ORDER ISSUED ................................................ DATE ...................................................... BY ....................................................... . . ....................