Permit City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
II
•
•
T I GARD
October 7, 2008
Apollo Drain & Rooter Service
2208 NW Birdsale Ave., #8
Gresham, OR 97030
Attn: Jamie Serbick
Re: Permit No. PLM2008 -00308 & SWR2008 -00111
Dear Ms. Serbick:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 12785 SW Pacific Hwy
Project Name: Burgerville
Job No.: N/A
Refund: ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $540.12.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as job was given to another contractor. Refund 80% of
permit fees.
•
•
If you have any questions please contact me at 503.718.2430.
Sincerely,
■_- I -
Dianna Howse
Building Division Services Supervisor
•
Enc.
I: \Building\ Refunds\ Administration \LtrRefund- CancelPermitdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard or.gov . TTY Relay: 503.684.2772
City of Tigard
TIGARD Tidemark Refund Request
This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Apollo Drain & Rooter Service DATE: October 2, 2008
2208 NW Birdsdale Ave., #8
Gresham, OR 97030 REQUESTED BY: Dianna Howse
Attn: Jamie Serbick
TRANSACTION INFORMATION:
Receipt #: 2008 -2563 Case #: PLM2008 -00308 and
SWR2008 -00111
Date: 7/21/08 Address /Parcel: 12785 SW Pacific Hwy
Pay Method: CreditCard Project Name: Burgerville
EXPLANATION: Per applicant's request as job was given to another contractor. Refund 80% of permit
fees.
REFUND INFORMATION:
Fee Description From Receipt 'Revenue Account No Refund
Example: >LBUILD]. Permit Fee i; . _ :Example:. ;245- 0000 - 432000 $ Amount'
[PLUMB] Permit Fee 245- 0000 - 431000 $482.24
[TAX] 12% State Surcharge - 100 - 0000 - 207020 57.88
TOTAL REFUND: $540.12
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager
If under $22,500 Department Manager
If under $50,000 City Manager
. If over $50,000 Local Contract Review Board
• FOR TIDEMARK SYSTEM ADMINISTRATION USE . ONLY / 0
`` f Case Refund Processed: I Date: I / yd' r/d I By: I ,
I: \Building \Refunds \RefundRequest.doc 05/23/07
;`c:;::.= CITY OFTIGARD
_ I U�6��UOS •
, II I I :35:_OA�'I
13125 SW Flail Blvd. •
Tigard, OR 97223 503.639.4171
C
Refund Receipt #: 27200800000000003466 /E % <� c 41 "L --
Date: 10/06/2008
Line Items:
Case No Tran Code Description Revenue .Account No Amount Paid
PLM200S -00308 Reversal - [PLUMB] Permit Fee 245 - 0000- 43I000 (482.24)
PLM200S -0030$ Reversal - [TAX] 12% State Sur 100- 0000 - 207020 (57.88)
Line Item Total: ($540.12)
Refund:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
Credit Reversal SCOTT BIRD - APOLLO DRAIN 05850D Fax (540.12)
& ROOTER
Refund Total: ($540.12)
•
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r ., CITti OF TIGARD 7/21/208
i 13125 SW Flail 131 rd. 3:37:07PN1 " l:igard. O 97223 503.639.4171
- TTIGA
R eceipt #: 27200800000000002563 e x16-m }-c__
• • Date: 07/21/2008
Line Items:
Case No Tran Code Description Revenue Account No Amount Paid
• PLM2008 -00308 [PLUMB] Permit Fee 245- 0000- 431000 602.80
PLM2008 -00308 [TAX] 12°,4 State Surcharge 100- 0000 - 207020 72.34
Line Item Total: $675.14
Payments:
Method Payer User ID Acct. /Check No. Approval No. H ow Received Amount Paid
CreditCard SCOTT BIRD - APOLLO DRAIN DEB 05850D Fax 675.14
& ROOTER
•
•
Payment Total: $675.14
•
•
•
•
C'•eP.30. 2008 2:12PM No. 4536 P. 1
•
• Building Division RECEIVED
Request for Permit Action
TIGARD; SEP 3 0 2008
•
TO: CITY OF TI(;iA1tD CITY OFTIGARD
BUILDING DIVISION
Permit System Administrator
13125 SW Hall Blvd,, Tigard, OR 97223
Phone: 503,718,2430 Fax: 503- 59S.1960 www.tigard- or.gov
FROM: ❑ Owner ❑ Applicant ,j Contractor ❑ City Staff
(check ono)
REFUND OR Name: _
INVOICE TO: (Business or b ,) ) &
• fC.> �� �r� = �
Mailing Address: �i J �) i r Z ! G
� 1 t, C L, it- v.4 . - - -
VOID City /State /Zip:
1d /2 /0 Phorie No.: j iJ ()
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( ✓):
CANCEL ' 1,RMITAPPLICATION.
PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
n REMOVE CON'rRACTOR FROM PERMrr (do not cancel permit), //
X'exxnit #: ? L m LC�.K.) -001/A_ l &4312_9.daB - r, / //
Site Address or Parcel #: � r ` C r _, _ r
Pzo ect Na e: r } r •
Subdivision Name: Lot It:
EXPLANATION: 1-1 ).: 1 % '1 G Ch ; .ti .. IQ (ICJ 1 2`LL
(')y r 2 e>E PaY e -cd3 p R� -oo138
Signature: (�._ - ri:� l` 1 � ��.. � 7{.,c_ Date; / , JO �
Print Name; • = ` ii i (. s )`t' ( 1 1 ;',1))!
Refund Policy
I. The 1]Irectoe or Building Official may a uthorize the refund of
a) ony fce which was erroneously paid or collected,
b) not +no+.o then CCt' /O of the land use application The when an application is withdrawn or canceled before any review effort ho been expended .
e) not more than 80' /r of the land use application fee For issued peunita.
c) nor more than 8l1% of the building plan roriew fcc when an application is canceled before any plan review effort has been expended .
tl) not mote than 80° a of the building permit fee fur i<p++OCI permits prior to any fttspection reqqueeta
2. Refunds will he tetumed to the original Payee in the we niotltod in which payment wag received. Please allow 1 -2 weeks for p teees:in refunds.
Tn
•F'
ON I,, .,
CF> E''4
S •
Rte to Sys Admire: Date ILIMBEIVI25, Rtc to Bid: Admit% _ Date • f> /7O:' By ice;
Refund Processed: Date /40 lz".0 invoice Processed: Date 13 _
Permit Canceled: Date /. 2 O:i B• I Parcel Tag Date _ B
Receipt #de —:.6 Date e2/ .' Method Amount .-
I: \Barring \Dourer \RrgPermit tetion.d R v 05/24/06 " " —
hl. 21. 2008 10:31AM MI/ a ' 4/tY No. 2502 P. 2
res
' •r it alia':tid
Plumbtn �•
: uilding Fix 1' c two
• ', I ', 0,10 FOR OFFICE USE ONLY
+ '
Rec eived
City of Tigard Date - . f /, . i/ A
q 13125 SW Hall Blvd., Tigard, 0 {OO Plan Review Ocher Permil No.: 45/4,4,440g...4) 11 I Phone: 503.639.4171 Fax: 5 03. 98.19 �� ;
Inspection Line: 503.639 "4175 \ \.. Dale Ready/By; �t Juts Supplemental El See Page 2 for •
'1'ICnliu Interact: www.tigard Or.gov '�� 10 D(oriP�ed/Method: 7 /.� /0 't r
��
- ..: ....... ... :.:_.,, . .:...: -.. -: ; ' =� ' - E , SCHEI> .... LE' en . a .. u - ormation
• .. : :: ` � �: ..: : : "`::
.._. _..... .. � !T YPE 0 . l -
0 • �∎ i, : ton
Dcscri • For .ecial! nrnrarlon eehecklE Total
New construction non
TA Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 R. for each utility connection)
`: _ :. : : :•: ; :. is :i: C .0i4:OR1' OF .GOi'4 . 11: •: - :: : ;= -i :,;=i:: , . SFR (1) bath 24920
.
El 1- and 2- family dwelling . Commercial/Industrial SFR (2) bath 350.00
SFR (3) bath 399.00
D Accessory building 0 Multi- family -
Each additional badilkitchen 45.00
❑ Master builder ❑Other: Firc sprinkler (_ sq. ft.) Page 2
., - ...: : : FOR ri rl1VD : . - : c.4 191!C_ : . " : ::':i Site utilities
- ._.........; •_;).013 31TE:Y
Job site address: 1 2_1 G I) i W 1.., Catch basin or area drain 16.60 /6).
City/State/ZIP: r ow) • / ZZ Drywall, leach line, or trench drain 16.60
�
Footing drain (no. linear R.: ____) Page 2
Suite/bldg./apt. no.: Project name: c „ . r Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: i 0 Page 2
✓'I
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: Page 2 IM
Subdivision: Lo no.:
Fixture or Ilem
Tax map /parcel no.; Absorption valve 16.60
_....... _ :.... :.::,,, ...:.• ..:. ....: °'" RYPI` 1( dN-: t) 1F `!
�. OR1C : `- r : :::i 7 '; . -: Bnckflow revcnter Page
_. ... ..... ...... 1) CSC
IN I` OM .� OVI /f d_ a41 (h � Backwater valve • 16.60 , . ffial
r + � �, Clothes washer 16.60
_ r- Dishwasher 16.60
_• .. _ fountain
. :� P120FER' �X 'iQM1Elt:_�'_:"_ '_�_ � _ 1 'ENAN7
Drinking
Ejectors/sump 16.60
Name: Expansion tank J 16,60 4 40
Address: Fixture /sewer cap 16.60
City /Stale/ZIP: Floor drain/floor sink/hub 1 tl 104,, 16.60 r/,L_ t a
Garbage disposal 16.60 MOM
Phone: ( ) Hose
., : - 1660 Mlita
.. s . �►PPLXCANT ::;•,:.:,. = ` Ice 16
Fax:
H bib
.... ..:......._,.... .. Aker � i l
Business name: I. ATI / %I' Interceptor /grease trap 16.60
Contact name: A/ of a� a / _ Medical gas (value: $ ) Page 2
Address; Primer q 16.60 fira
r �
Cily /State/ZIP: • / i /, /j /��‘ Roof drain (commercial) 16.60
Sink/basin/lavatory • ►�. 16.60 7 3
Phone: ( 0) / .40 • Fax: ( ) Tub /shower /shower pan NM 16.60
Email: Urinal
. ..,, . :._
._.... .. •: :. _.
... =:C RpCLOR: ::•::.',t2::::= _ Water closet iMi �i'.ti
1660
Business name: W1 i i , Water heater 11.11 16.60 , r�
Address: �, � ` , Other. IPM1
Subtotal MB / ,
City/State/ZIP: earg 0. 9 71 ,r Minimum p unit fee: $77,50 I P
w �. , ' R esidential bac kflow minimum permit fee; $36.25 ' ,�
Phone: 1�) �, • 6 ■ J F () o • -'o 3
Plumbing Lie, no. . C j=l3 p 1i Plan review (25 /o of permit fee) ►���,ii F
,...4 State surcharge (12% of pcmlit fee) �l, l'
Authorized signature- �' � TOTAL PERMIT FEE _ ‘A
, �A. `. Date / 1 / !, This permit application c:rpires If a permit is not obtalnc within
ler �/I 180 days after it bas been accepted as complete,
p_?
*Fee methodolog set b Tri•County Building Industry Service B
1:\ ml�s\PLMF -PC lAppAOC 12/77106 a 616 T(0 T(i00/02/C0D ) 1P1
. Jul. 21. 2008 10:31AM No. 2502 P. 3
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
, Fee ea " fo .Sg
cal
. ,.........:...:. :-: � .: :,= ;'.::;- ::::. ::��'��.;::: �::- �:.. � - .:._:: utre:' Footage: � Peranit�laee:_ �: �: ��� :; .::� : : :: :. . ::: . .� . :. . . :
Site U.:tllltres • ,. ...,:..:: _ • $115.00
0 to 2,000
Footing drain 1 1 00 ' 55 .00 2,001 to 3,600 $160.00
Footing drain - each additional 100' 46.40 3,601 to 7,200 5220.00 -
Sewer - 1st 100' _7,201 and greaser $309.00
Sewer - each additional 100' 5456..°4°0
—
Water Service - 1st 100' 55,00 Medical Gas Systems:
Water Service - each additional 100 Valuation:; ermzt ee: _;'.:..
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5.000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and 51.52 for each
additional $100.00 or fraction thereof, to and
e o
Totat i. additi n a $10,000.00.
CommerciM Back Flow Prevention Device 46.40 i u
$10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential each additional $100,00 or fraction thereof, to
(minimum ,ermit fet $36.25) t e and including $25,000.00.
65.25 $25,001.00 to $50,000.00 ' $379.50 for the first $25,000.00 and $1.45 for
Rain Drain, single family dwelling each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and . 000 in $50 000.00.
72.50 $50,001.00 and up $742 for the first $50,000.00 and $1.20 for
Subtotal; r— each additional $100.00 or fraction thereof.
Commercial Fixture Wor Plaln"Rev>lei. for:Pluiinihin nstallatzons
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
* [) Any new commercial building with water service 2
accuratel re art fixtures could result in increased se wer fees greater, except systems designed and stamped by licensed
and
censed
,......- .. >:;. : Q,iatitlty b l?irltire .W.ork Perlbrmed :
. y ,.. .. :. . ll eplai:.o: _.
engineer.
Flinure'I ge _:. :.: _" ❑ New exterior plumbing site utilities for any complex structure
. .. � . : ,:- ..-:� ..::.... ..:...:.....::: "•_::. C;evto us.: s::. Cpaped `:.=:
Baptistry/Font _ as defined in 0AR918 -180 -0040.
Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities.
•Jacuui/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Swill ❑ Any complex structure as defined in OArt918 -780 -0040.
—
-Drive Thru _ —
Cu jidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial ,
Domestic :- etric Or= Rrelr I50n1 "'' "':: _
: D is $ iiiii :
Drinking Fountain ti isometric or riser diagram is required for new buildings
Floor DraiNsinl 2"
Fye Wash ----- j -
that meet the qualifications above.
A3
- 4 „ t •
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial _ -,
-Industrial
Ice MachiRefri Drains _
Oil Separator (Gas Station)
Rec. Vehicle Dump Station - _
Shower -Gang _
-Stall
Sink - Bar/Lavatory - 2 Note: If fixture work under this permit results in an
-Bradley
- Commercial —
increase of sewer EDUs, a sewer permit will be issued and
-Service — - _ 4 - - . fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued,
Washer - Clothes
Water Extra
Water Closet - Toilet _ �'
Urinal er
Other Fixtures: /-
St J MI /U - ( llwod v CO Oki c,rI."7
S Qv
r
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
11111
T I GARD
October 7, 2008
Apollo Drain & Rooter Service
2208 NW Birdsale Ave., #8
Gresham, OR 97030
Attn: Jamie Serbick
Re: Permit No. PLM2008 -00308 & SWR2008 -00111
Dear Ms. Serbick:
The City of Tigard has canceled the above referenced permit(s) and enclose a refund for the
following:
Site Address: 12785 SW Pacific Hwy
Project Name: Burgerville
Job No.: N/A
Refund: • ❑ Check # in the amount of $
® Credit card "return" receipt in the amount of $540.12.
❑ Trust account "deposit" receipt in the amount of $
Notes: Per applicant's request as job was given to another contractor. Refund 80% of
permit fees.
If you have any questions please contact me at 503.718.2430.
Sincerely,
•
C r d -
Dianna Howse
Building Division Services Supervisor
Enc.
•
I:\ Building\ Refunds \Administ ration \LtrRefund- CancelPermitdoc 01/16/07
Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772
a
City of Tigard
TIGARD Tidemark Refund Request
• This form is used for refund requests of land use, engineering and building application fees.
Receipts, documentation and the Request for Permit Action or Refund form (if applicable) must be
. attached to this form. Refund requests are due to Tidemark System Administrator by Friday
at 5:00 PM for processing each Monday. Accounts Payable will route refund checks to Tidemark
System Administrator for distribution. Please allow 1 -2 weeks for processing.
PAYABLE TO: Apollo Drain & Rooter Service DATE: October 2, 2008
2208 NW Birdsdale Ave., #8
Gresham, OR 97030 REQUESTED BY: Dianna Howse
Attn: Jamie Serbick
TRANSACTION INFORMATION:
Receipt #: 2008 -2563 Case #: PLM2008 -00308 and
SWR2008 -00111
Date: 7/21/08 Address /Parcel: 12785 SW Pacific Hwy
•
Pay Method: CreditCard
•
Project Name: Burgerville
EXPLANATION: Per applicant's request as job was given to another contractor. Refund 80% of permit
fees.
REFUND: INFORMATION: r
Fee Descri tion From Recei ' -
,.. , ,,,,P, .r. pt .. Repenue Account.NO: ' •_ ��'. • Refiind� �.�
,[BUILD]- Permit.Fee.• _ 'Exam le:';245'UQO 4 „:.
p Q= 32000• "=•��. :'•$.A�iount�.
[PLUMB] Permit Fee 245- 0000 - 431000 $482.24
[TAX] 12% State Surcharge 100- 0000 - 207020 57.88
•
TOTAL REFUND: $540.12
APPROVALS:
If under $500 Professional Staff
If under $7,500 Division Manager � I •
If under $22,500 Department Manager
If under $50,000 City Manager
•
. If over $50,000 Local Contract Review Board
• :::::' .; FOR TIDEMARK SYSTEM ADMINISTRATION USE.ONLY:::
&.' ^r Case Refund Processed: I Date: I /0 11 I B I .y •
I: \Building \Refunds \RefundRequest.doc 05/23/07
_, CITY OF TIGARD to/woos
•
•
V
13125 SW Hall Blvd. I I :35:26AM
. x Tigard, OR 97223 5113.639.4171
TLGARR;
Refund Receipt #: 27200800000000003466 l,...E14 -4' `' c.„
Date: 10/06/2008
Line Items:
Case No "Tan Code Description Revenue Account No Amount Paid
PLM2008 -00308 Reversal - [PLUMB] Permit Fee 245-0000-431000 (482.74)
PLM200S -00308 Reversal - [TAX] 12% State Sur 100 - 0000 - 207020 (57.88)
Line Item Total: ($540.12)
Refund:
Method Payer User ID Acct. /Check No. Approval No. Flow Received Amount Paid
Credit Reversal SCOTT BIRD - APOLLO DRAIN 05850D Fax (540.12)
ROOTER
Refund Total: ($540.12)
•
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•
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CITY OF T1GARD 7/21/2008
13125 SW Hall Blvd. 3:37:07PM
Tigard, OR 97223 503.639.4171
1 IGARD.
Receipt #: 27200800000000002563 t)/'6,'V11_.
Date: 07/21/2008
Line Items:
Case No Trait Code Description Revenue Account No Amount Paid
PLM2008 -00308 [PLUMB] Permit Fee 245- 0000 - 431000 602
•
PLM2008 -00308 [TAX] 12% State Surcharge 100 - 0000 - 207020 72.34
Line Item Total: $675.14
Payments:
Method Payer User ID Acct. /Check No. Approval No. How Received Amount Paid
CreditCard SCOTT BIRD - APOLLO DRAIN DEB 05850D Fax 675
& ROOTER
Payment Total: $675.14
•
•
Sep. 30. 2008 2:12PM No. 4536 P. 1
I
Building Division RECEIVED
• Request for Permit Action
TIGA D SEP 3 0 2008
CITY OFTIGARD
of CITY OF TIGARD BUILDING DIVISION
Permit System Administrator
13125 SW Hall Blvd., Tigard, OR 97223 ,
Phone: 503.118.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner ❑ Applicant At Contractor ❑ City Staff
(check ono)
REFUND OR Name', ,--..., .
INVOICE TO (Business or individual) () 1 10 pox 1y1 ,...v gc)(5)-(f4_,.. � '7e r: (,
Mailin Add r w e ,i _ a.. Q. .41 '
V 0 1 D City/State/Zip: /1
ity /State /Zip: 1 /l.� `. Y.i{�1 f 7Q` C•1 77()
/13/2/0 4 y� Phone No.: DX. j ' 2. ?D . ` NC-- ) I
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (✓):
CANCEL ,RMIT APPLICATION.
PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
El REMOVE CONTRACTOR FROM PERMIT (do not cancel pernut).
X'ettoit #: 1 (Y) . 2 D 00101 Qaaos - co «I)
Site Address or Parcel #: 1 �• / � ' C j 1 1,x) -� :. /c
P.toject Name: - .A i( Z; t .vO • ........ -
Subdivision Name: Lot #:
EXPLANATION: r ; -.. , . ) ' S //') 1'�1() 1 Cy ,eA ,, 001,44q ;IQ CIO /2L
I (
. 3 - , I �_ 11 I C � 1- - a_ - ' _.
t .)y. ,/ , • . / - ` - 0.1.. 4 t1y g- ce3g�,51c01P oR- t� /38)
Signature: (_ _ - '1-1.t L • ` ;f.•k , - Date: 6)/ >, log
Print Name: __jzx
R efund Policy
I. Me Director Of Buleimg Official may authorize the refund oF.
a) any fee which w erroneously paid or collected.
b) not mote than AM of the land use application fee when an application is withdrawn or canceled before any review effort hz been expended.
c) not more than 130t/e of the land use application fee foe issued peunits.
c) not more than 87% of the building plan review fee when an application It canceled before any plan ceriew effort has been expended.
ti) not mote than AM of the btllding permit !cc fir istue(I pettnits prior to any inspection reqquesta.
2. Refand5 will be warmed to the original Payee in the sense method in which payment was received. Pirate enow 1 - weeks for peocessiRe, refunds.
:rte Us IN. - -,1 , . .. , t.<;
Rte to S e Admit): Date MtbrIlm , Rtc to Bid: Adrnint - ry Date By
Refund Processed; Date /OAF- E Invoice Processed' Date B
Permit Canceled: DAtt f' 2 0-AN B • ;;�� I Parcel Tag Added: Date -_ B
Rer:ei t #4,-. 4. (, Date e2/ - Method c _ Amount $
l:\ Buil •' saouns \ReciPemmitAetion.d• ll v0S/24/OG