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. < < , <br /> � � REFUND AUTHORIZATION <br /> T0: City Treasurer Date io-25-zooi <br /> You aru hereby authorized to refund the following: <br /> PAYEE: Providence Everett Medical Center <br /> Attn: David Wachob <br /> ADDRESS; Po xox 1067 <br /> Everett WA 98201 <br /> AMOUNT: $ Z010.94 <br /> REASON: Overcharge un plan check fee due to change in valuntion fur TI for Breaet <br /> Center at 900 Pacific Ave. (2784.28 less 773.34 - 2010.94) <br /> CUSTOMER <br /> ACCOUNT # 002-345-8300-831 <br /> This amount was received by the City of Everett on 10-18-2001 and recorded on <br /> �a.c.t <br /> permit or receipt number sotio-o3a <br /> io-zs-zaoi �� %�� <br /> �d�tel IAuthodz�d Sipn�Nn) <br /> Tim Tyler, Building Official <br /> Rtl�l <br /> Refund by Check No. Date , <br /> _ Original Receipt Attached <br /> Account Debited: <br /> Or refund noted on Treasurer's Office Copy <br />