621 5TH AVE S.PDFIIIIIIIIIIII
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621 5TH AVE S
APPLICATION
for
The City of Edmonds SME SEWER PERMT
NEW CONSTRUCTION Cj REPAIRS E] EASEMENT No . ..........................................
104-04750
Wa 1 t P.ayne
OWNER------------------------ -- -- ------------------------------------------------------------------------------- CONTRACTOR .................................................................................................. PERMIT No . ......................
ADDRESS ....... �'Zj ... ..... 5th ... Ay.en-g.e._S ................................................... LEGAL DESCRIPTION: LOT No. ......................................... BLOCK No . ............................................
Lu
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UL-
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b-A
LA
V
0
NAME OF ADDITION
DYE TESTED 01N SEWER
JULY, 1972
Approved:
DATE................................................ By ......................................................................