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[ifiFUND AU'1.i0f.l'/.A'PION <br />To: Cicy 'Pruanuruc �?�� �a- ry `�-S <br />You arc hereby authotized to refund [he tollowing: � <br />Payee: QLLQ.✓� L LEvv. Co.z�S>�U�T�nti� <br />Address: �'GC�Tr � lS'OX ���'� <br />L021G G'EGC/� Gl/A• � Zip ��-1� <br />nmo�nc: $ /o9/r�. �/a <br />Reason: /.�/GPr'Q�dTI� Fo,P ST,PEcG'T fi�t/D <br />/_Ai✓DC'G4i�iNLT Ir�,�,c'ovE��Ei✓T.( <br />I'✓J/'i� C�';�JJJAC'i L L% <br />Customer <br />Account No. <br />This amount was received by the City of Everett on // -/S 19c� <br />and recorded on City Treasurer's ReceipC No. �:iJ (n �% <br />❑ City Permit No.__ has been returned/cancelled. <br />❑ PLans have been retur�.ied co this department. <br />❑ A charge has been made Co the customer's accounC for this refund. <br />------�' _ - .- � <br />�- � �/_-��� <br />� ? s �� �,..-� � : , . . <br />Date j utfiorized Si�ature <br />�"i1�Llc `c��G�c�' !`/.�-�' <br />Titic <br />_ ""' _ " """""""' """"""""' """' " _ "' _ ""' _ """"" _ "" _ """""""' _ _"' _' _ _ _ "" <br />Refund by CVieck No.l� �,%�� � Date "'�-�-�% 19 ��` Uriginal Receipt <br />a <br />Account Uebited: <br />Fund Basub Elem Uti1 Obj <br />or <br />A[tached <br />i � w � w <br />Refund Noted on <br />' ' �-`J ` � � `-�"� Treasurer's <br />Office Copy <br />r-i r <br />�3 � <br />H r <br />� � <br />�� <br />cn <br />�� <br />t�3 ` <br />r� : <br />�. . <br />� <br />H <br />a- <br />O; <br />�'. <br />-� <br />?1 . <br />T <br />: <br />