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CITI' OF EVERETT <br />PUBLIC DISCLOSURE REQUEST FOlt INFORMATION <br />1'bonc: (425) 257-N(10 Fax: (425) 257-8741 2930 Wetmore Ave., Everett, \VA 98201 <br />$.15 per page for costs of copying (Tide 42 R.C. W) <br />Requestor's <br />Printed Name: / <br />Business Name: n) J40 S <br />5 <br />11 <br />and/or <br />/L Signature: <br />Address: ,372.5 ??8�� S� SW e-mail: �arG���/bOSetbb• LOt� <br />Sr- l-er � <br />Phone No.: 206 I 776 / irate: If your Phone has a block on it we cannot contact you. <br />Please contact us after five business days. <br />Allow me to: inspect _request <br />a copy of the following records: Please be specific. <br />l7%S lt7r �7��� C��Z�i l�rbk�lj <br />If record(s) concern individual(s) other than requestor. Please state. <br />Is/are the requested record(s) to be used for a commercial purpose? <br />Yes _No <br />