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9 <br /> �� � <br /> everett <br /> REFUND AUTt[ORIZATION ' <br /> To: City Treasurer Date � ��-��Q� <br /> Yau are hereby authorized to refund the following : <br /> PS ee: L�/1 'i��� %� � —`�r1 'r �� ii ��•/l'r'L��/�''�}LI <br /> y - ,v� <br /> Address : �si.�1������� "" <br /> � <br /> L�x Nti'�� GAziP 4�n.�, <br /> Amount � ^ ' �,11.;li; C"t(�lZE2l`Il.l�J �'�71��% <br /> r <br /> ' Reason: ' ' � l�riL�� I <br /> � - ) � ' /. � � i <br /> Customer ' <br /> � � <br /> Account No. j <br /> This amount was received by the City of Everett on /-�'c�3 19� <br /> . and recorded on City Treasurer's Receipt No. • <br /> � ��City . C�• Permit No.JU� has been returned/cancelled <br /> . `/ <br /> ❑ Plans have been returned to this department. <br /> ❑ A charge has been made to the tomer' s account for this refund. <br /> �a� ���� u orize Signature <br /> ate <br /> �l_I/�� �^a'�cCl�£n <br /> �J itt e <br /> � <br /> Refund by Check No. Date 19 Original Receipt <br /> Attached <br /> Account Uebited : Fund Basub Elem Util Obj <br /> .2?, ,j�l �C C�-�. ��;�, . � . � . � �� ��L. $3larRefund Noted - <br /> _' L�• � ,'3.��. ;L�� ��(�(�. .C^•:('.•`�3J --on Treasurer� s <br /> /���t�'----- -- ' L\C, � j�..� � � C�L� L'C' �5.3� O£fice CoPY <br />