Laserfiche WebLink
s <br />��i1F't9 r=d,6't:f'�,Gl`�/1 TC� <br />�- �� .-�. ,�; � � / <br />--:'% i -riG�.. �>, y <br />�.s- <br />�%3 <br />�-� ,.� <br />=° _' - REQUEST P'OR RGCOkDS <br />CITY CI,ERY.' S OF['ICE <br />EV�RSTT, I]ASHIIIGTO[d <br />����n��,� <br />'1' ° , t981 <br />, 2., <br />,. ....................................._.........____..._ <br />CITY OF EVERETT; <br />f'ubllc Works Dept, <br />Print .� <br />Name _!;;l( l-�i? cl��, _ ,.ianature �'�>���,.,,, _ <br />/ .. <br />Address 53:,'i- ��.-�,.C� ��:2.<'ll,c.� <br />�a v /i ,/ Telephone �'��-��%��'� <br />--� x'.�-e��/.'��ril.-�/w,�Tc„� tdunber Z.� 5->-`��i�� �1S8-7YG.3� <br />Recor:ls <br />Requested <br />� <br />..��,r .l' c-�.c;e'-L'C- <br />Request- --�== <br />Recvd. b}• `'_'_'� l l c>� `( ., Dare 'j - > �; - ,}"/ Time �,/. / � f �,:� <br />Signature <br />- - - - - - - - - - - - - - - - - - - - - <br />Request P.eceived <br />forwarded to �=iv�.iiYe„-i�� I3y <br />Department <br />Response Due Date s`j --� 7, �{, �� � sy� <br />/ <br />** Department receiving tl�e request sliould attach inLorriation r.equested <br />or a staiemenL- as L-o why ttie record is not beit;g dispensed and <br />return to the City Clerk for issuance to requestor. (Ord. 313-79) <br />Dclivered Date <br />Exempt _ Time <br />Attachme�rts <br />'��`'�' `)� P •'`<<J.--J .1-. <br />11CTION 'PAIU.N ON RliCORU <br />RL�UL'ST <br />Clo. Pages Certified <br />No. Copies <br />Lmployees Sign. <br />