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CITY OF EVERETT <br /> REFUND AUTHORIZATION <br /> TO: City Treasurer DATE: December 10, 2021 <br /> You are hereby authorized to refund the following: <br /> PAYEE ADT Commercial <br /> & 600 Oakesdale Ave SW, Ste 100 <br /> ADDRESS: Renton WA 98057 <br /> AMOUNT: $ 40.00 <br /> REASON: CONTRACTOR REQUESTED REFUND. NO WORK PERFORMED. REFUND AT 80%. <br /> GL CODE: BLDG 002-322-1101-831: <br /> PL CK FEE 002-345-8300-831: I " OICE: E2112-074 <br /> MECH 002-322-1500-831: A n Ricardo Valenzucla <br /> PLMB 002-322-1300-831: (Plea tint this number on the • and check) <br /> ELEC 002-322-1200-831: S40.00 <br /> SEWER 401-343-50-109-460-00: <br /> SYST DEV STORM 401-379-50-123-460-14: <br /> PW REV 002-345-8312-831: <br /> PW INSP 002-342-4016-831: <br /> PAVING 002-322-4014-831: • <br /> OVERPAYMENT REFUND 002-369-8101-000: <br /> Payment was submitted to City of Everett on 12/10/21 via online credit card payment and recorded on permit <br /> E2112-074. <br /> December 10, 2021 0.� XId <br /> (date) (Authorized Signature) <br /> Sabrina Good— Permit Services Manager <br /> (Title) <br /> Refund by Check No. Date <br /> Original Receipt Attached <br /> Account Debited: <br /> Or refund noted on Treasurer's Office Copy, <br /> ‘i UlkAn OA WA <br /> 1 1 IP <br />