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CITY OF EVERETT <br />REFUND AUTHORIZATION <br />TO: City Treasurer <br />You are hereby authorized to refund the following: <br />PAYEE <br />ADDRESS: <br />AMOUNT: <br />PHIL ROHMER <br />6910 ROOSEVELT WAY NE <br />SEATTLE WA 98177 <br />$120.00 <br />DATE: March 3, 2023 <br />REASON: WRONG ADDRESS ON PERMIVt." �<O <br />GL CODE: BLDG 130-332-1101-831: <br />PL CK FEE 130-345-8300-831: INVOICE: E2209-194 <br />MECH 130-322-1500-831: (Please print numbers on the refiind check) <br />PLMB 130-322-1300-831: <br />ELEC 130-322-1200-831: $120.00 <br />SEWER 401-343-50-109-460-00: <br />SURCHARGE 670-389-3060-000: <br />PAVING 130-322-4014-831: <br />FIRE DEPT BLDG PERMIT RVW/INSP: <br />CREDIT CARD FEE 009-500-0057-494: <br />EXCESS PAYMENT NOT IN COMDEV 130-322-1898-831: <br />Payment submitted to City of on 11/24/2022 via online. <br />March 3, 2023 J&-aw ad) <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 />REVISED 3/3/23 NEW GUS <br />