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'` <br />� <br />0 <br />everett <br />. <br />REFUND AUTFIORIZATION <br />�p y�.G�l9�l�� <br />,3-2s/-95� <br />To: City Treasurer <br />You are hereby authori ed to refund the following: <br />Payee: <br />Address: 7n �n .�i' n i�r+.� / yTi/ , <br />� �! ; <br />Date ' 3'9 <br />�� . i <br />' ' _/ ! y � / /i // / 1 <br />/ / � / <br />�� � de�is �[�' <br />Customer <br />Account No. �a/-3�3Soln9y/o�i3 <br />IThis amount was received by the City of Everett on -,3 3 19 <br />I and recorded on City Treasurer's Receipt No. ��� � <br />� <br />❑ City _ __ Permit No. <br />has been returned/cancelled. <br />❑ Plans have been returned_to this department. <br />❑ A charge has been made to,the cust er s account for this refund, <br />Y <br />ate A orize Signature <br />Building Official <br />Tit e <br />---------------------------------------------------------------------------------- <br />Refund by Check No. Date 19 Original Receipt <br />Attached <br />Account Debited: Fund Basub Elem Util Obj <br />or <br />Refund Noted <br />�� on ireasurer's <br />OEfice Copy <br />