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23822 80TH AVE W
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APPLICATION
for
The City of Edmonds SIDE SEWER PER1MIT
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CARD No . ......
EASEMENT No . ......................................
'I ul - 4K Lj
. . ........
OWNERY'f ...................................... CONTRACTOR
................................................................................................ PERMIT No.
STREET ;0—e
........................... ................... AVENUE LOT No . ..... �7 ----------------------------------------------------------- BLOCK No . ...............................................
HOUSE No.191-4 ........... &�v .........
NAMEADD. . ......................................................................................................
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Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ ................................. ...........
SEWER WORK ORDER ISSUED .......................................... --�3 ----- By . ............ . ................
DATE .... A .............. ---- ----
NOTICE:
No warranty of accuracy.
The information 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 o.n these
map(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
t e -map(s), including, but not limited to,
the loc'ation 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
emp-l-oyee-s o-r office-rs shall be liabale for the
information given on this map(s), nor for
any one representation provided based
upon said map(s),