311143 05/09/17 ' ,+u,Cgq�f
�. CITY OF CARMEL, INDIANA VENDOR: 356355
ONE CIVIC SQUARE KENT SHAFFER BUILDERS, INC CHECK AMOUNT: $*****1,600.00*
,? r4 CARMEL, INDIANA 46032 8649 E 250 S CHECK NUMBER: 311143
+y. ZIONSVILLE IN 460» CHECK DATE: 05/09/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 MAY 102.00 OTHER EXPENSES
659 5023990 MAY 1,498.00 OTHER EXPENSES
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CITY OF CARMEL
4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: plux
COPY # 1
Sec: Twp: Rng: Sub:A83 Blk: Lot:60
PARCEL ID . . . . . . . . : 1610260012004000
DATE ISSUED. . . . . . . : 03/17/2017
RECEIPT #. . . . . . . . . : BC000013115
REFERENCE ID # . . . : 17030105
SITE ADDRESS . . . . . : 5956 KIRKENDALL CT
SUBDIVISION . . . . . . : BROOKS LANDING AT PRAIRIE VIEW
CITY . . . . . . . . . . . . . . CARMEL
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : LARKIN, TOM & RUTH
ADDRESS . . . . . . . . . . : 5956 KIRKENDALL CT
CITY/STATE/ZIP . . . : CARMEL, IN 46033
RECEIVED FROM . . . . : KENT SHAFFER BUILDE
CONTRACTOR . . . . . . . : GRAY'S MAINTENANCE LIC # XGRAYMAI
COMPANY . . . . . . . . . . : GRAY'S MAINTENANCE
ADDRESS . . . . . . . . . . : P.O.BOX 55
CITY/STATE/ZIP . . . : WESTFIELD, IN 46074
TELEPHONE . . . . . . . . : (417) 867-2600
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
USEWERINSP FLAT RATE 1.00 102 .00 0 .00 102 . 00 0. 00
USFSEWCONN FLAT RATE 1.00 1498. 00 0 .00 1498 . 00 0. 00
USFWATCONN FLAT RATE 1.00 2961. 00 0.00 2961 . 00 0.00
UWATERTAP FLAT RATE 1 . 00 117. 00 0.00 117.00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 4678 . 00 0.00 4678. 00 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 4, 678. 00 37430
---------------
TOTAL RECEIPT 4, 678.00
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