HomeMy WebLinkAboutPermit Miscellaneous 2009-6-26
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CITY OF SPRINGFIELD, OREGON
Development
Services
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Springfield,OR97417
Plwne:(S41)726-37S3
Fax: (S41) 726-3689
www.ci.lpfiIlclIeldor_UI
REQUEST FOR REFUND
DATE: /f-80 -,09
PERMIT #
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PROPERTY ADDRESS:
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MAPLD& TAXLOT#: )70 ~3S- "-IIi) >DOt.0
R!n request is ein& made for a refund: :2??1t'" _ A?W<:7AO ~J..-r' 4JI--
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MAILING ADDRESS.: ~5 [?9f:.. ~ nr () J/uuf)
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PHONE~~7-<j),?s 1.5
The information requested above must be completed in order for a refund to be processed,
Refunds will only be made to the person who paid for the permit or application, Approximate
processing time will be two (2) weeks from the date refund was requested,
FOR OFFICE USE ONLY
ApPROVAL: ~D
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DATE:
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RECEIPT NUMBER:
~\tu\ J'&D~ to ~a Hopper to prote s td _ }jo
04-20-09 POl :42 IN
225 Fifth Street
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Spnpgfield, Oregon 97477
541,:726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
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RECEIPT #:
2200900000000000337
Date: 04/06/2009
10:34:14AM
Paid By
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
37.70
37.70
$75.40
Job/Journal Number
COM2009-00440 -
COM2009-00439 --
Description
Plan Review Residential
Plan Review Residential
Payments:
Type of Payment
Cash
Amount Paid
SPRINGFIELD MOBILE HOME nJm
PARK/MJIM
In ~erson
$75.40
-/I#;
Payment Total:
,
$75.40
cReceintl
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4/6/2009