HomeMy WebLinkAboutPermit Miscellaneous 2009-6-26
1-
w.f~
CiTY OF SPRINGFIELD, OREGON
Development
Services
225 Fifth Street
Springfield,Oll.974TI
Phonc:(S-41)726-37S3
Fu:: (S4I) 726-3619
www.d.Iprin&f\cId.......
REQUEST FOR REFUND
DATE: /f-80 -,09
PERMIT #
oo/..f3Q
Of) .iN /J
1b2-"'6,j -~~A'1
~
)70 ~3S- "-IIi)
41- 'P" .
:1~/'" j 'i ~-fL q .l
;;;)Ot.0
PROPERTY ADDRESS:
MAP LD & T AXLOT #:
R!n requestjspein& made for a,refund: ~ .A?W<:7AO.A..J-r- .ilzH-
~ ~ <~ozJ:;. J<1P3Jbh fl-2~
,{,_~ h t.J! JI.... /VI. ~ ~ 'ao. l""P.f~/ ./~,:(J1~t!/f~
:Ji.6.~ '" ~ ';..(~ ~
~~:illA-;= ~7 '7'..kQf' . M~ /7~ oU7 ,
5'~~LI':,}~m 'I, ...".~~o-
, ^ (/ ~ ~ 1:L,) rJ-t x,(;Q ~ ~
/YW ~ ~ca, "'-'-' 7A Lk'.....,..J ~
q U u -" v~--
......................................................................
=~o/ fu2
MAILING ADDRESS: ~5 [?9f:.. kAlO J/uuf)
C~ M.yjfhSeJ
PHONE: ~~/7-?).?<
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
APPROV AL: ~D
~~-~Q\J
\)
DATE:
\ Q .~ k'CP\
RECEIPT NUMBER:
~\tu\ J'&D~ to ~a Hopper to proce srefon _}jo
04-20-09 P01:42 IN
225,Fiftb Street
Sprillgfield, Oregon 97477
541-.726-3759 Pbone
Job/Journal Number
COM2009-00440 .-
COM2009-00439 -
Payments:
Type of Payment
Cash
cReceintl
RECEIPT #:
~
I'
City of SJ~ingfield Official Receipt
DevelopnJient Services Department
I'
Public Works Department
II
II
Date: 04/06/2009
"
Ii
I:
"
,
Item Total: II
Check Number Authorization lj
Batch Number Number How Received
"
2200900000000000337
10:34:14AM
Description
Plan Review Residential.
Plan Review Residential
Paid By
Received By
SPRfNGFIELD MOBILE HOME njm
PAR!<IMJIM
Page I ~f I
Amount Due
37.70
37.70
. $75.40
Amount Paid
Iri' Person
il
Payment Total:
$75.40
$75.40
j'
'1
:,
I.
Ii
II
I,
Ii
"
J>
i'
"
,
I:
Ii
,
'.
Ii
II
I
4/6/2009