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161793 07/23/2008 CITY OF CARMEL, INDIANA VENDOR: T361548 Page 1 of 1 0 t ONE CIVIC SQUARE GARY DICKERSON f CARMEL, INDIANA 46032 4585 SERUM PLANT RD CHECK AMOUNT: $59.00 THORNTOWN IN 46071 CHECK NUMBER: 161793 CHECK DATE: 7/23/2008 'DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 101 5023990 59.00 OTHER EXPENSES REQ UEST COMPLETE RETURN g REFUND Q THIS FORM TO: A Cit of Carmel Buildinb Code Services Y Ph. (317) 57I -2444 Fax (317) 57I -2499 Building Code Services One Civic Square; Carmel, IN 46032 PERMIT #(s): Lot Subdivision, or Address of Construction: loi 131 �601 Cree C �9� Dri wC)C)6 fir. (If more than one address needs to be listed and will not fit, please attach a printed list of all 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: Fh e- Lipp V C 0� c,, r 4 U c-&, S6n �,-n D c e rs ©n P061 �aS Chas �,ecl �dr Out ex�ca. �►�z�ec�fic�Y, v� as ��'r ne ctecl v� he xi ci h di no o r TOTAL REFUND AMOUNT REQUESTED: a�i fb rt e� 17 I Applicant Signature U Date �G�Yy� ��G�YSOYI Y CCu�lf �1 Pool Applicant Name Printed Company Name (If applicable) APPLICANT ADDRESS: Street Address aw city ST zip 114 oV IV) 3� a g a Phone Fax FOR OFFICE USE ONLY p Total amount for fees that ARE available for refund; p Fees that are NOT available for refund: 7 p Refund approved by: Date: 0 p Date submitted for Payment: Amount. Approved: T. r REFUND REQUESTS MUST OCCUR WITHIN RESIDENTIAL PERMITS Within 180 days from the issuance date of the permit. COMMERCIAL /INSTITUTIONAL/MULTI- FAMILY Within 1 year of the issue date of the State Commercial Design Release (CDR) there NO CDR they need to begin within .1 year. of the issuance date of the permit. FEES WHICH MAY BE REFUNDED ARE Inspection Fees. Count the number of inspections charged on an ILP application (assessed by plan review). Certificate of Occupancy or Substantial Completion Fees. To be refunded. PRIF Fee. To be refunded. Fees (re- inspection, late fees, 'other" inspection fees): Refunds can be made if it has been determined that a "clearly defined error" has been made when a re- inspection, late, and /or "other" fee has been assessed. NOTE: If an ILP has gone beyond 180 days for start of construction, no refund can be generated because the ILP is technically invalid/ expired. If, however, the applicant has requested, and has been granted, an extension of time prior to the 180 day dead line, a refund could still be granted, all under the terms as outlined above. DOTE: Applicants requesting refunds for sewer and /or water permits should be directed to the utility provider. (CarmelUtilities or'CTRWD.) S:Permits Forms/ Refund Request Form Fra r s r IRS p PRO S IM IT MEM. v v 4 N* M l a g �t 7 �S ol la Y m, x MI! M CE3 E t a r Y.. i a r M 1 p• m p� W W n p° s 6 gi p p. s a i p g a t 4i4 4ap m;,. 0 �i 0. a 3ti g 8. mY:i a .ffi ♦m 0. i liW .ma e-. as i a p o .W m a i d H d f a 4 8 W Ss: t ds k T a t a yy�� yn A g dt TB P f fg q t d 3i ff d W Y xf f f 4 t 96.:� t fdn' a ,g 1. 'k '!g .K .m i. g g m CR@ p 8 1 S•' ge+ 9 W t 8 E 9 f a F p''irr.. p W p fl T s a tl�' s s -t p m Y a m A! cf i E 4 kr' 6 p a k :fk i 9. k'b pS W. H i 8 k. p a f .m i p A f W !P 5 v kL i ffi d S f i kd S Tt W t. C 3 a R Z i a •tl Aga g 9 a ax @s.. a• r k k 4 k l� r y Prescribed by Slate Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 7V�Cl 0 a Total rQ. 0 0 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 I p IN SUM OF A� ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 69 00 bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 7 oZ/ 200 i natu,�e Cost distribution ledger classification if Title claim paid motor vehicle highway fund