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everett <br />To: City Treasurer <br />1i <br />REFUND AUTFIORIZATION <br />� �, �S/93o i%a�de,�.� <br />L <br />You are hereby author'zed to refund the following: <br />Payee: ���D_ ////1/Yl/Yl�li � <br />Address : 2G 20 ,L� �D/�,�(/� / <br />�Jh°n�l.r: z i p—��ec�� <br />Amount <br />' Reason: <br />i <br />i <br />i <br />i Customer <br />� Account No <br />; <br />� <br />;• <br />; <br />i <br />i <br />�' / <br />� � i. / /L'. .. �l ' / <br />� � � � , <br />/ i � / <br />Date /� /�'-9� <br />.c�a.� c%a���cL <br />� �/�//lJ�/�./ <br />This amount was received b he Cit• f Everett on_GC71 /3 19 %3 <br />and recorded on ' C����Yl���y�ee�Ps--�io 7�� 2 <br />❑ City Permit No. has been returned/cancelled. <br />❑ Plans have been retui•ned to this department. <br />❑ A charge has been made to,the cu tom r�s account for this refund. <br />/�'�1 : � �� <br />ate Aut orize Signature <br />Building Official <br />S <br />��'���'�������������������_���'_��_��_ " �'��" ��'��'_��'���'����_������'�_�_��_�'� <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 Treasurer's <br />Office Copy <br />- �� <br />