23416 75TH AVE W.PDFlill iiiiiiii
6021
23416 75TH AVE W
Or STNEff FILE APPLICATION
for
The City of Edmonds SIDE SEWER PERNaT
OUTSIDE INSIDE E] REPAIRS n
0
0
CA-RD No . ......................................
EASEMENT No . ................ .....................
OWNER........ ............................. CONTRACTOR .............. ........ .............................. - ................ PERMIT No.
175 Z4 STREET
HOUSENo. —Q�L ........................................................ ................................. AVENUE LOT -No . ...................................................................... BWCK No . .............................. ................
NAMEADD . ........................................................................ ..........
C 17 1: Cli
C, <:
E
L .0
APpRoj(ro
14� 8 1,%3.
NtSERVIC E LATEMA).—
Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ .........................................
SEWER WORK ORDER ISSUED ..................... ..................... DATE
�Y' ............