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540 PINE ST
The City of Edmonds
APPLICATION
for
SIDE SEWER FERAHT
OUTSIDE [:] INSIDE [-] REPAIRS
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WNER....... .. . .................................................................................. CONTRACTOR ..........
STREET
1E No.. ---------- AVENUE LOT No.
HoUiM No__ .4m
NAME ADD . ..............
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Date
BACKFILL WORK ORDER ISSUED ....................
SEWER WORK ORDER ISSUED ...........................
I
DEPOSIT, $ .............
CARD No . ..................
EASEMENT No . ..................
................................................... PERMIT No.
........................................................ 13LOCK No . ......................
.................. . ------------
............................ ------ ...... . ................
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Approved: '
DATE .....................
APpROVEO
�I,J� 26 1963
By ........... 7 . ............ . ........... .....
.................