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22815 76TH AVE W
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APPLICATION
The City of Edmonds for
ILE SIDE SEWER PEIMT
—1 F OUTSIDE INSIDE E] REPAIRS
CARDNo . ......................................
EASEMENT No . ........................... ----------
OWNER ..... dh-1-2. e15 ......... W62 ............................
CONTRACTOR.2L)/,/-l��C-.,x.:��/"
MI
PER T No.
HOUSENo . ....... ................ Z. ...... --- Sz�
STREET
AVENUE LOT 'No . ......................................................................
BLOCK No . ...............................................
NAMEADD . .............................................................................................................................................................
F - -
(2-Z0`0 '7
BACKFILL WORK ORDER ISSUED ......
SEWER WORK ORDER ISSUED ............
76 vlY 'I Iric-
DEPOSIT, $ ...................................
.1
DATE................................................ By ....................................................... ...........
NOTICE:
No warranty of accuracy.
,The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).