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COgt(-G4 <br />CITY OF EVERETT <br />PUBLIC DISCLOSURE REQUEST FOR INFORMATION <br />Records Department Phone: (425) 247-8918 Fax: (425) 257-8882 <br />3200 Cedar St., Everett, WA 98201 <br />Date: S. )0, 0 S <br />Requestor's <br />Printed Name: r' rcQ N / vvk, and/or <br />Business Name: <br />Signature:-f-�F�• bA ��� <br />f <br />Address: S'/ /0 f � "- ' i/;"," '4 f;G e-mail: Gc n an 'r _, /76/'— <br />�Vt-f_e,r7' �iR�a3 <br />Phone No. /f� ; y l' �� Note: If your phone has a block on it we <br />cannot contact you. Please contact us after <br />five business days. <br />Allow me to: <br />Please be specific. <br />X inspect / <br />TP <br />request a copy <br />G A ✓' P //g rTr <br />of the following records. <br />7- /,r / p ,y r A-)n r-r <br />If record(s) concern individual(s) other than requestor, please state. <br />Is/are the requested record(s) to be used for commercial purpose: — Yes J; No <br />