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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 />& <br />ADDRESS <br />AMOUNT <br />REASON <br />SIDE-SEWER <br />PO BOX 137 <br />MUKILTEO WA 98275 <br />'� • : 11 <br />DATE: August 2, 2016 <br />Contractor is requesting a refund, as-#he ELECTRICAL wor#� is not going to take place. <br />GL CODE: 002-322-1101-831: <br />002-322-1500-831: <br />002-322-1300-831: <br />002-322-1200-831: <br />002-322-4011-831: <br />401-343-50-109-460-00: $48.00 <br />401-343-40-119-471-02: <br />002-345-8300-831: <br />002-369-8101-000: <br />157-345-8601-000: <br />Permit U1512-032 & U1512-033 — <br />original fee paid $60.00; 80 °/a refund as <br />work was cancelled after permit was <br />obtained, address did not qualify for City <br />backflow program. <br />Payment was made with CREDIT CARD to the City of Everett on 12/21/2015 and recorded on permit. <br />August 2, 2016 y V�� <br />(date) (Authorized Signature) <br />Refund by Check <br />Date <br />Original Receipt Attached <br />Paul McKee <br />