Laserfiche WebLink
r'� � SERVICE �^ � <br /> CITY OF EVER� � ORDER NO. J I u « <br /> APPLICATION FOR WATEti SERVICE <br /> (� �7� //,/-. EVCRETT.W�SNINOTON.�S� �A�� / J% <br /> R[CEIVED OF � . ,til� .CI,��(:1;,.�J - " . --_f_L:Z�- . .. . <br /> �_�f <br /> THE SUM OF DOLLARS GENTS <br /> y <br /> � FOR�--�ONHC TION AT BLK LOT�._-AOD. � <br /> 1 t /1 /� i. FIXED_f.tia r <br /> NO �� 7 �'G"�'f"!�� �� �i � STREET � <br /> � <br /> 2. GVATER_S__�- <br /> (� _ � 3. DEPO5IT—f -� <br /> AECEIV � <br /> �� 2 .3 O .�� BY-----:��=�.� �_« .� <br /> a <br /> C. D. Hills <br /> Payee: <br /> 1007 14th East <br /> Addresa: Y <br /> Scattic , Wa . 98112 <br /> Zip <br /> Amount: $ G0 . 00 <br /> Reaeon: Duplication of Permit N22163-G/19/7A <br /> Cuetamer <br /> Account No, <br /> Th1.r amount vas ceceived by the City of 6verett on i/15/ 19 g1• <br /> and recorded on City Treaeurer's Receipt Iru. <br /> 40531 <br /> � CS[y Water permit tio. 3784 hae been returned/cancelled, <br /> ❑ Plane have been returned to. thie department. <br /> ❑ A charge hae been made to the cuatomer's account for [his refund. <br /> / ' � , <br /> . �/�-" r ,; ; <br /> �i�6ie� � � ��: -- -__ <br /> Date Authorized Signnture <br /> Office Manager <br /> Title <br /> "-.'-------------'----------------------'-------------------'----------------'-�--'- <br /> Refund by Check No. Date 19_ Origlnal lieceipt <br /> Attechad <br /> Account Debited: Fund Baeub Elem Util Obj <br /> or <br /> u • • L�i w � � �+--' �Eund Noted on <br /> , � w � ' ' �--i-' Treaeurer'e <br /> Office Copy <br />