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everett 38�3 ���mze�J�ve� <br /> REFUND AUTfIORIZATION <br /> To: City Treasurer Da[e �,i-� <br /> You �re hereby authorized to refund the following: <br /> Payee: ��p'C'��/ OiJ7.Pl7 <br /> Address: [)/ _�2/�D/lr ,�liJr�/ <br /> f.�ut� /�lA Zip 96'20.3 <br /> nmount $ �j yJ` (�Q <br /> ' Reason: ( �iill.t(M�on� /UQ�c2 NAr'//QAQ.� GY Ct�G(JcttLL.Q-�'G• — <br /> � ; �� - �-,��� <br /> Customer ��5' ���ilC� �"Q'C��1`'U1ZO�`�GCQ.c�/' <br /> Account No. ,S/�/�-,�y3Uo1/9y7ioZ <br /> This amount was received by the Cit of Everctt on�/�93 19_ . <br /> LC.�LtIiL,•.�PiLv(.G(.i 0� <br /> and recorded on ' t No. 770/ <br /> ❑ City Permit No. has been returned/cancelled. <br /> ❑ Plans have been returned�to this department. <br /> � ❑ A charge has been made to ,the customer's account for this refund. <br /> :o-�/-93 —�7i���r�� <br /> Da[e t� ut orize Si�nature <br /> ➢uilding Official <br /> Tlt e <br /> ------------------------------------------------'---'-------------------•�-------- <br /> Aefund by Check No. Date 19__ Original Rcreipt <br /> Attached <br /> Account Debited: Fun.� Dasub E•lem Util Obj <br /> "__, .y, o r <br /> ReEund Noted <br /> `L `� on Trcasurcr' � <br /> Office Copy <br />