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CITY OF EVERETT <br />PUI3LIC DISCLOSURE REQUEST FOR INFORMAT[ON <br />Phone: (�2� 257-8610 <br />Requestor's <br />Printed Name: <br />Business Name: <br />Fa:: (425) 257-3741 293f� Wetmore Ave., Everctt, WA 9820I <br />S.1 S per page jor cosrs of capying (Title 41 R.C. If'.J <br />and/or <br />• Signature: _ (�-rit. �! � �� <br />Address: ��d ��!/ C!/1�J-d�'. L L• e-mail: J o a h� t�llSP ./1 e C, <br />.� • <br />. <br />Phoao No.: 4�s zs� yyr3 Note: If your phone has a blcek on it we cannot contact you. <br />PIease contact us after five business days. <br />Allow me to: _ iaspxt ✓request a copy of the following records: Please be specific. <br />�;�e P�Q�1 _. <br />If record(::) concem individual(s) other than requestor. Picase state. <br />[s/are the reyucsted record(s) to be used for a commercial purpose? _Yes ✓ No <br />. -� <br />