317831 10/26/2017 a ur G�q*
a *� CITY OF CARMEL, INDIANA VENDOR: 372018
4 ONE CIVIC SQUARE B&R ELECTRIC LLC CHECK AMOUNT: $**......70.00`
CARMEL, INDIANA 46032 6940 W 200 S CHECK NUMBER: 317831
+.�. NEW PALESTINE IN 46163 CHECK DATE: 10/26/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 322010 REIMB 70.00 BUILDING PERMITS
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.199
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
R I Payee
G L Purchase Order No.
Terms
I o / c
II&W #� Q- �5�'t"C ! in- `T tel tP3 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
o �1 re M re u,es-�- - r r ns CV�- -7 0 . o
N o -f Gc 4 14- LLQ LrA s
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Total D . D D
hereby certify that the attached invoice(s), or bill(s), is (are)true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20-
Clerk-Treasurer
20Clerk-Treasurer
a C4f,*, REFUND REQUEST "`coMl>1i-rc&REnlluv
11-11S FORM 1-0;
Building Code Services City of C'annel
Ph.(317)571-2444 Fax(317)571-2499 Building*&Code Services
One civic Square;
a n i au a Carnx1,IN 46032
PERMIT #(s):___V7 i 0 0065
------------------------------------
Lot & Subdivision, or Addressa
onstruction:
_ __ _ ____ Al
_��G__��c�f►�-i9✓�� Cc-t 1 r'►e_ �lV i Gni--------
(if more than one address needs to a listed and will not fit,please attach a printed list of all permits.with
their corresponding permit i.)
Please print or type the reason for the requested refund, and specific fee or fees
which are requested, in the lines below:
-r Pd +k P r1 Cfa f�Pt c�v, 1.7 S PC
L f r1e e
TOTAL REFUND AMOUNT REQUESTED:
I10 -1G�-1-7
- ----------------- -------------------
gnaturs Q Data
Name-Printed Company Name(if applicable)—
APPLICANT ADDRESS:
------- L—i------------------------------------------------
Street Address
,A/e,, P4 I P s+.P7 Q r,✓ '6I6 3
-------------------------------------------------------
C" ST ZIP
317- -36% 2.zl
------------------------- ---------------------------
Phone ! Fax
FOR OFFICE USE ONLY:
p Total amount for fees that ARE available for refund: ---------—-----—
p Fees that are NOT available for refund: _ � _-_
p Refund approved by:--------------------------------- Date:--------------
------------
p Date submitted for Payment:--------------------------- Amount Approved:----------------
CITY OF CARMEL
ITEM 1 OF 1 PERMIT RECEIPT OPERATOR: nmishler
COPY # 1
Sec: Twp:18 Rng:03 Sub:586 B1k:23 Lot: 98
PARCEL ID . . . . . . . . : 1709230203012000
DATE ISSUED. . . . . . . : 10/12/2017
RECEIPT #. . . . . . . . . : BC000014544
REFERENCE ID # • • . : 17100065
SITE ADDRESS . . . . . : 106 HARMONY RD
SUBDIVISION . . . . . . : VILLAGE OF MOUNT CARMEL
CITY . . . . . . . . . . . . . . CARMEL
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : KINGSTON, LINDA
ADDRESS . . . . . . . . . . : 106 HARMONY RD
CITY/STATE/ZIP . . . : CARMEL, IN 46032
RECEIVED FROM . . . . : RYAN WHITE
CONTRACTOR . . . . . . . : B & R ELECTRIC LIC # B&RELEC
COMPANY . . . . . . . . . . : B & R ELECTRIC
ADDRESS . . . . . . . . . . : 6940 W 200 S
CITY/STATE/ZIP . . . : NEW PALESTINE, IN 46163
TELEPHONE . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
IRESELEMTR PER INSPECTIO 1. 00 70 . 00 0 .00 70 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 70 . 00 0 . 00 70 . 00 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 70.00
---------------
TOTAL RECEIPT 70. 00