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Amount: $ �(J •'7 3 '�' . <br /> Initials: l'� <br /> REQUEST FOR REPRINT OF OVERSIZED DOCUMENTS <br /> OR BUILDING PLANS AND BLUEPRINTS <br /> Date of Request: _�f„ /�i <br /> �Name: ' � n �� v ;� `� <br /> Address: ��(r �7 7 ���.� <br /> A� <br /> City: /�.�J� � ��, State: �/�� Zip: _��-.� _3-:i <br /> Phone: (Work) �U � � � �f �� �� � (Home) <br /> Description of document(s) to be reprinted: <br /> CHARGES: (the follo�,�ving c:�arges aze subject to rate changes) <br /> Oversized Documents from Mi�rofilm <br /> The charge for such reprints is the cost of copying service, Messenger service and a minimum <br /> clerical fee of $5.00. <br /> Buildin� Plans and Blueprints <br /> The charge for such reprints is the cost of copying service, Messenger service and a minimum <br /> clerical fee of $5.00. <br /> All char�es must be paid at the time of the request, and are non-refundable. Requests must <br /> be picked up ut the Ciry off cPs unless other arrangements have been made. If prints are <br /> delivered an� Ficked up by a courier service, the charge for such service is to be paid by <br /> requestor. <br /> --��.� _ �c� <br /> � �� �--. <br /> .----J SiQnature <br /> /_� (�Z/ b <br /> C.O P <br /> {,�vr���, <br /> �.J� <br /> J�.�rz=; <br /> ` ,�0. �3� <br />