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Receipt PLANNER 1/24/2023
SPRINGFIELD City of Springfield Development and Public Works Transaction Receipt 225 Fifth Street N/N Record ID: 811-23-000013-TYP1 Springfield, OR 97477 541-726-3753 N541-726-3753 IVR Number: 811095285581 Fax: 541-726-3689 permitcenter@xpringfield-or.gov Receipt Number: 487270 Receipt Date: 1/24/23 hftp:lN .sprn9Wd .9oWOwlC,rtWOe WmWDW m.h6n Worksite address: 1920 OLYMPIC ST, SPRINGFIELD, OR 97477 Parcel: 1703254201601 Fees Paid Transaction urits Description Account code Fee amount Paid amount date 1/24/23 1.00 Fa Type l- Drinking Water Protection 100-00000.425002-1039 $1,325.00 $1,325.00 Overlay Disitct, City & UGS ................................................................................................................................................ 1/24/23 1.00 Automatic Technology Fee 204-00000.425605-0000 $66.25 $88.25 Payment Method: Credit card Payer: Chad Pollock Payment Amount: $1,391.25 authorization: 565441 Paid through ePermitting website Receipt Total: $1,391.25 Pnnf d 11262310:02 am Papel a1 FIN TrmexemRecapryr