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23900 80TH PL W
APPLICATION CARD No . ..... - ...................
for
SIDE SEWER PERMrr
The City of EdmondsO WC.L. i OUTSIDE 0 INSIDE 0 REPAIRS 0 EASEMENT No. ................. ............
3 —0 7zop /cs)
R - ................................................................... ............................................ CONTRACTOR .... ............ - .................... ......................... ...... .. - ........ I ....... PERMIT No.
OWNE / ............ 6-�'; �: 7
—, '-Z 'S�C4- " STREET
HOUSENo. f! ... �./ ...... I ........ ...................... d . ..... 4� ..................... ............................. AVENUE LOT No . ................... ........................................................ .. BLOCK No . ......................................... ..............
NAMEADD ............ - .............................................................. ............................ ..... .. ...... .. ... ..... .. .... ... ....... ..... ....
Date Approved:
BACKFILL WORK ORDER ISSUED ..................... ............ ......... DEPOSIT, $ ..................................... .......... --s
DATE..
SEWER WORK ORDER ISSUED ................................................ ............ _,t�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 �Eclmoncls does not warrant the
accuracy of anything set forth on these
map(�_). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
tf�e -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
ernpl-oyee-s o-r officers 'shal'l be 1--ia-b-1--e for +Lhe
information given on this map(s), nor for
any one representation provided based
upon said map(s)..
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(�-). Any person or entity -requesting a
copy should conduct an independent
inquiry regarding the information shown on
tf�e -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
ernp-l-o-yee-s o-r officers shall] be Hlabl-e for the
information given on this map(s), nor for
any one representation provided based
upon'said map(s).