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"D ' " <br /> Receipt <br /> Washington State Department of Labor and Industries <br /> Customer: STEPAN SAVCHIK <br /> Address: 10115 23RD AVE W <br /> City: SNOHOMISH State: WA Zip: 98204 <br /> -- Fiscal Transaction Receipt -- <br /> Fiscal Transaction: 104995202 <br /> Created: 11/4/2015 <br /> Payments: $44.90 <br /> -- Payments -- <br /> Type Amount Payer Reference <br /> Credit Card $44.90 STEPAN SAVCHIK 1226511514 <br /> -- Services -- <br /> EP2573777 <br /> Description Reference Quantity Price <br /> -Single or Multifamily Resid EP2573777 672 $44.90 <br /> NOTE:All refund requesls must be made in writing. Refuncl.s may requi�e processing through <br /> central office and we cannot gua�antee imn�ediate refun�ing of se��vices. <br /> http://f eld-services.apps-inside.lni.wa.gov/FrontCounter/P'CIZcvRecWeb/ReceiptPrint.asp... 11/4/2015 <br />