166715 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 362240 Page 1 of 1
ONE CIVIC SQUARE DAN HOMAN
CARMEL, INDIANA 46032 13675 SMOKEY RIDGE DR CHECK AMOUNT: $59.OD
CARMEL IN 46033
CHECK NUMBER: 166715
CHECK DATE: 12/1
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 59.00 REFUND
Sara,,, "COMPLETE RETURN
REFUND REQU EST THIS FORM TO:
Buddr7 Co de Services City of Carmel
Ph. (3I7) X71 -2444 Fax (3I7) 571 -2499 Building 6x Code Services
One Civic Square;
WIN Carmel, IN 46032
J D�
PERMIT #(s): 09 1 9
Lot Subdivision, or Address of Construction:
9k j
(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:
T)uk 1e rte, �P of ALL L t1 i n s�e CA 6Y L; Das VieQ cleat
4 r- 4L i ;'Jo's
VIU
69 -5e d 14c tr Vre) ai V A 9 a
TOTAL REFUND AMOUNT REQUESTED:
Applicart Signature Date
01,1 4M Cx v\
Applicant Name Printed Company Name (If applicable)
APPLICANT ADDRESS:
Street Address
city Sr zip
F
Phone Fax
FOR OFFICE USE ONLY
p Total amount for fees that ARE available for refund: 9 r
LO
p Fees that are NOT available for refund:
p Refund approved by: j rr Date:
p Date submitted for Payment: �—r- t G' 1 TA Amount Approved:
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 is NO CDR they need to begin within 1 year
of the issuance date of the permit.
FEES WHICH MAY BE REFUNDED ARE
O 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 deadline, a refund could still be granted, all under the terms as
outlined above.
NOTE: Applicants requesting refunds for sewer and /or water permits should
be directed to the utility provider. (Carmel Utilities or CTRWD.)
S:Permits Forms/ Refund Request Form
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
4
ACCOUNTS PAYABLE VOUCHER
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
0-f'l fi- i'►')n Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
1 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
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
�G
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
rya 3� 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
200
Si6at re' C_..S'
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund