Laserfiche WebLink
i <br /> ,';� ` � I <br /> '� �� ,Y:�CI��o��r <br /> � ' �._ � <br /> � <br /> �v •rr T(�R'7'GL,47i�f FORlt9 SEP ?5 7013 ; <br /> !'+ � <br /> e�..n�loi 'L^�'1 ���4'i;1�fuA @ � <br /> ' Pu�,uanl lo f.hipler A.S6 o(Ih^ Revlscd Codc or WB:hlrv�ton(R4N), C�tT� �,'j�j'�f <br /> � Ih.l;fwtn L lor lil'�np a trnl Jalm agnlnsl Ihe Gty of Evr.rett. °.on�r,of <br /> . U��e Informatlon �cqucsted en tld; fann i: r�pu�red hy RCV�' 4.9u.0?0 cur aca u.� e � <br /> � anA may I+�suhjed lo{ril�lic dL•tlosme. The dly Cleik Is thc Clp�: ,_ ,"}(��, � � <br /> dr,IpnaleJ ;ipe�N (r.r th^ purpose of mcclving dahns. Cluhn/oinis � 1 � n 'j t <br /> . cannotbe.suLnJffadc%ctrt���Ically(�i:�c•nrallorinx). — �'L-- ; <br /> --------- --- ���—S��OSJr_`'�� i <br /> ,, , .. .. , �. <br /> I <br /> I!I�F.ASFTYf'E OR�.Cfi�1NT.-tL�ARLY IN yNIC>.��<. ` �.-. .. . .. , . .• . , .. . . ^ . . .. I <br /> t-0all oi deiivcr orlginal si9nrd clalm fm�m to: Offl[c of thc Clly Cludt � .� <br /> City of Everr.lt <br /> Rusin�ss Hmn�s: 2930 YJeNioro 11vo,�Stc. 1•A <br /> 14on.—I'rl.,8 am.l0 5 p.m.,PaciflcTimo Evurott,l'!n 99201 I <br /> f.InseJ nu city holidays '� <br /> CLAIM tA�TIYF�IIMA7IMJ; I <br /> i <br /> 1.Oximant's namr. � <br /> f�orrCSl _ _. _ �<f15�018� _ HaI15_'___ ____ U3/01�1975 <br /> ' L�stmnr, Gmt Mkica: �D.vfeola+th(m�t'dd}Yfl) <br /> 2231 Rockofeller�vc L"ve�ett, WA �J8201 <br /> 1.Currentfe5ldentlala�{Jmss: _'_'.'__.._-- _—__-_—_--__—.___-_-'.- ' <br /> 3.1•taIlln9adJressQFAlllcrwQ: S�m'_ ---- - --- . . <br /> q. Resldentlal adtlrrs;at thc Ume o(Ihc In:ldcnl(II JlRemnl fmin cunenc eddress): . <br /> ti.clalinanCs Idcpponc nwn�ri: _125-2zft_1936_. 2U6-90J-U6l�l _ 206•694•49tS5__ <br /> /ianc Cedl Ai,hress _ I <br /> c.aain„nt�scm,iaadr�s;: __krislo(erforros�"�li�lmail.com _ _._ _ __. —_ __ <br /> Ir ci - UNFoaaln7lnN: � <br /> 7.�alc nl Incidenl: _��/0(i12013 _ 'I"iinc: .___. .. _ ���.���. ��P.�t�. (chrck ons) i <br /> (rr�NJ,1/151'8 �. <br /> 0. I!ihr Intldr.nl ativned m•ri �i PCtlod ol tlmG dale nl Orsl and I<<s[aarrences: �i <br /> (mm: Tlmc'' ___I I n.m. 17 p.�n.(chrcl on^J �°�m.�VnAhYYv) Timc'___ _(7 a.m. I]p.m.(d�ect anr7 <br /> �(nin�'JdhYIY) <br /> v.locatlanufinc�d�na �'�� ���ohomish _Cverelf---__--_-- '231 Rockolc�IlerAve. <br /> .RN,cunArnm��' Gry:f/npp.:'ral!^ 1'i,ariM;crt�oixuncd <br /> l0. I(UiC InGdent w.Nned at a chrrt or Itl�,7hway: � <br /> _Il�__—.. _"—_"' _ _'—dtP.l,�:c�cnnnn;fhrrn:.rrt'N(bY:(Dv�S(nW _ —_' I <br /> .. .:�m�el�L<rt arMS��rvwy , <br /> no..ovm� ; <br /> � I <br /> � a <br />