23214 75TH AVE W.PDF1111 lill 1111
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23214 75TH AVE W
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APPLICATION
for
The City of Edmonds SIDE SEWFM rFJUM
STREET FILE OUTSwto, INSIDE 0 REPAIRS Q
............................. ....... CONTRACTOR ------ C ..... ........... .
OWNER --- ---------- .................................
...........
STREET
HOUSE -No. ........... ....... . 4 —1 -------- AVENUE IA:)T No . ........................................................
NAMEADD - --------- ------------------- ---------------------------
17,
C
Date
BACKFILL WORK ORDER ISSUED ......... — ....................... DEPOSIT, $.. .............
SEVVER WORK ORDER ISSUED ------------------- ............ --
CAMU-N&
EASEMENT No . ......................
------------------- ----- - ..... PERMIT No. k4
............ BLOCK No - ---------------------------------
------------------------- -------------- ------------------------------
Kpproved:
------- ---
DATE ............. By