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APPLICATION CARD No . .............................
for
Y SEUMR PERMIT
The Cit " of Edmonds STREET FEE EASEMENT No . ......................................
- OUTSIDE 0 INSIDE Ej REPAIRS
03 - 9,0.6— A� I-V /0-jV
....................................................
CONTRACT .........................
OWNER ............... ........ OR ....... PERMIT No.
I STREET
HOUSE No. ............
................................................... AVENUE LOT 'No . ...... 0/ ................. .......................................... BLOCK No . ................................................
NAMEADD . ......... -------- ................... .......................................
R
APPROVED
2 9_ 1963
Date Approved:
BACKFILL WORK ORDER ISSUED ................................... DEPOSIT, $ ................ ............................
DATE ..... IL
SEWER WORK ORDER ISSUED ............... .......................... ..... By
. . ........ . ....................... .....................
j
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 on these
map(�-). Any person or entity -req uesting a
copy should conduct an independent
inquiry regarding the information shown on
tFe -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-1-o-yee-s o-r officers sha-111 be lia-b-Ife for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).