HomeMy WebLinkAbout07060039 Correspondence
REFUND REQUEST
Building & Code Services
Ph. (317) 571-2444 Fax (317) 571-2499
....COMPLETE Cst RETURN
THIS FORM TO:
City of Carmel
Building Cst Code Services
One Civic Square;
Carmel, IN 46032
PERMIT #(s):
070100039
Lot & Subdivision, or Address of Construction:
~d..30 '-to qio'+h ,N. ~~~~Lf.0~46
(If more than one address needs to be listed and will not fit, please attach a prin ed list of a permits, with
their corresponding permit #.)
Please print or type the reason for the requested refund, and specific fee or fees
which are requested, in the lines below:
--1D \ cha.o-Q. 'Qfl WJ.A
Applicant Name - Printed
cJt d.. 77. 5'0 lLD..e. '"P ~ F...J2 D
1M, 00 ~ ~6~f/filrYl../
i?3.CC ~ ~~~o"
~~~.~ ~
~.&d~-=~i 50 ~lhQ~c-~+-Ftwrid:",C~
TOTAL REFUND AMOUNT REQUESTED: .:.:tP~ ~ oH.o . e::J:::> ,
,
J<cwm ~oiJ (p-7-07 :
Date
I C5m ~ 1) uhaJU..A.-.>
Company Name (If applicable)
~"
R/YY) ~ ~
Applicant Signature
APPLICANT ADDRESS:
3~30 (-. qlP-th A+.
Street Addre~
c~
317 - ~+<j) . ~<6
Phone #
~
ST
J/4;cNfO
Zip
oi7~ 7D5~700 I
Fax #
FOR OFFICE USE ONLY:
o Total amount for fees that ARE available for refund:
o Fees that are NOT available for refund:
o Refund approved by:
Date:
o Date submitted for Payment:
Amount Approved:
S:Permlts/Forms/Retund Request Form
-
City of Carmel
Department of Community Services
Attn: Pam
Re: Outdoor Display Permit
Pam,
Please find our application for a temporary display permit for an event which will
be held June 13 - June 16. Please contact me at 317-590-3915 with any
questions you may have. Thank you for your assistance.
~
Michael Driver
General Manager
4150 East 96th Street . Indianapolis, IN 46240 . (317) 848-8888
I 'd 88El 'oN ~V9[:6 LOOl '9 'unr