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..9 City of Santa —ma ,n �1 COTC OUice Use Only <br />Clerk of the Council Y <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached agreement and all <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention requirements <br />have been satisfied prior to signing the termination form. (Ml K f °W THE (30( _ `L <br />Is the agreement(s) a permanent record? Yes ❑ No <br />)'' B 22'2J pHJ 0:52 <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The agreement with Building Code Services Inc <br />No. A-2022-072-03 was completed on <br />(List all amendments. Use space below if needed.) <br />1 iagreementslformsNorm - agreement termination torm_goldenmd.doc <br />2/10/2023 <br />and final payment has been made. <br />Department: Planning and Building <br />Phone/Ext.: 5113 <br />Signature: '_4 f/ XAW& — <br />Date: 2/22/2023 <br />