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CITY OF EVERETT <br /> PUBLIC DISCLOSURE REQUEST FOR INFORMATION <br /> Phone: (425)247-8810 Fax: (425) 257-8857 3200 Cedar St., Everett, WA 98201 <br /> Date: /�/1//d3 <br /> � <br /> Requestor's / �- <br /> Printed Name: A �jll � �/�P.La� and /or <br /> � <br /> � � � <br /> Business Name: � �• • S• <br /> Signature: - <br /> Address: . 706`j - Z�2 n S/['• S•W� � �� e-ma: : /��� -/'� <br /> rzca��r a�.,.Co ��- �iBU N► � ,o tnv. ►+•� <br /> Phone No.: Y�'1- ' 77Y' G�Z7 Note: If your phone has a block on it we cannot <br /> !'�,�, c�y�. �7-j y ,�b�� contact you. Please contact us aiter five business <br /> days. <br /> Allow me to: ✓inspecl ✓ request a copy of lhe (ollowing records. <br /> Please be specific. �/3� �/'� <br /> 7— <br /> If record(s) concern individual(s) othe t requestor piease at <br /> Is/are the requested record(s) to be �e�m�ial ose: � Yes � No <br /> �„ _ , , <br /> �,�� � J -�lc c-= <br /> :�- . � �" <br />