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CTTY OF EVERETT <br /> PUBLIC DI::CLOSURE REQUEST FOR INFORMATION <br /> Records Department Phone: (425) 247-8918 Fax: (425) 257-8882 <br /> 3200 Cedar �t,, Everett, WA 98201 <br /> Date: .-'ia '! ;� y :�c�c> `7 <br /> Requestor's , <br /> Printed Name: ���'�JOji� -S�'��G�i���% and/or <br /> Business Name: ��/ �y �'c>�)�n,��c /1 Ti-�,,2�� �/ <br /> � <br /> Signaturc: C�"' �r/.f��—�^�—�-� <br /> Address: �;� y/j (�i�.�//„/��;n �1✓_� e-mail: <br /> , �d�=�� 77" /.� �1.� zu� <br /> Phone No. `��" ' 3 3 y - /�h 4- Note: tf}�ou�phone has a block on it�t�e <br /> cannot contact you. Please contact us aRer <br /> five business days. <br /> Allow rie to: —inspect / —/� request a copy of the following records, <br /> ► � be specific. <br /> _ ��✓Z ��/� i i1=it/,s O/= C' ��rli�C %.�->.� � Si7i c �� T— 1�/�3J — 11�31 — <br /> _�,/�y/ C!!„/�„ ����;J A ✓� J�i/,s;,2 a' iT J�.� <br /> If record(s) concern individual(s) other than requestor, please state. <br /> Is/are the requested record(s) to be used for commercial purpose: _ Yes _ No <br />