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CITY OF EVERETT <br /> REFIJND AUTHORIZATfQN <br /> TO: City Treasurer DATE: 5-05-2011 <br /> You are hereby authorized to refund the fc�lowing to: <br /> PROVIDENCE MEDICAL CENTER <br /> 1321 COLBY AVE ��j, � j/f/J��.�.�'G��i,���`( <br /> EVERETT WA 98201 �f`. <br /> AMOUNT: $7,158.74 <br /> GIL CODE: $5111.89 002-345-3300-831 <br /> 2046.85 002-322-1'101-831 <br /> This amount was received on 3-17-2011 and recorded on permit B1103-029. <br /> REASON: This build out of the kitchen was originally a part of the Tower permit (60811-021) and <br /> was paid at that time. The job was divided in order to issue CO's. No charge on this permit. <br /> 5-05-2011 , t%� •�L�-�r <br /> (date) (AuthorK d Signawre) <br /> �irR Brook�uildina Offi ��� <br /> (Title) <br /> Refund by Check No. Date <br /> _Original Receipt Attached <br /> Account Debited: <br /> Or refund noted on Treasurer's Office Copy. <br />