208412 04/25/2012 CITY OF CARMEL, INDIANA VENDOR: 366182 Page 1 of 1
ONE CIVIC SQUARE PAUL OWEN CHECK AMOUNT: $2,485.80
CARMEL, INDIANA 46032 704 ADAMS STREET SUITE A
CARMEL IN 46032 CHECK NUMBER: 208412
CHECK DATE: 4/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
101 5023990 2,485.80 REFUND
kNL REFUND REQUEST THIS FOR i41 TO: v R1V
City of Carmel
Building Code Services
Ph. (317) 571 -2444 Fax (317) 571 -2499 Building &z Code Services
One Civic Square;
!rJ0la 11. Carmel, IN 46032
PERMIT #(5): 1D 3
Lot Subdivision, or Address of Construction:
'fit- 7 �nd: Q� 1 455i
(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:
Go, i o
3-565-7 00
TOTAL REFUND AiNIOUiYT REQUESTED: Act
1 t
Applicant Signature Date
Co
K k a od X --r�
.Applicant Name Printed parry Name (If applicable)
APPLICANT ADDRESS:
7c4 ,A S'T. STc A.
Street Address
i
0 3 Z
city ST Zi
4 353•
Phone Fax
FOR OFFICE USE ONLY C)
p Total amount for fees that ARE available for refund: 41 5.
D Fees that are NOT available for refund: 4,3 s c
Refund approved by: Date:
1
Date submitted for Payment: Y k 1 Amount Approved: IA 15
i
?ermrt {Fees x
PermitclnformatIvn
Permit Number 12 030022 Status Void
PARCEL ID 1710 210022007000 J
Address 14551 ALLEN PASS CT
Owner Name WEDG EWOOD BUILDING CO., LLC
r C HardCopy t 'Ct r f''A l t P Units Quantity Fee Amount Post Date Paid to Date Fee Balance
IRESFINAL !PER INSPECTION ua 6210 03/06/2012 "62.10F 0 00
IRESFTSLB iPER INSPECTION I 1 6210 03J06j2012 I 62.101 0.00
i IRESFTSLB+ PER INSPECTION l y 1.00 6210 03/06/2012 62 14 ().001
IRSR
EOUGH PER INSPECTION I 1 00 6210 03/06/2012
PRIF 14 DWELL ,UNITS 1.00 1337.00 03/06j2012 1387.00 0.00
j
RESC /0 I FLAT RATE 1.00 60.10 03/06/2012 60 0.00!
�RESSINGLE I �SQUAREFEET I 662000 1i620003/06j2012 152001 Q00
Fee Information [editlnformatton
After Fact
After fact 0
Fee Information-
Fee ID IRESELEMTR EL
u �Q) RES ECTRICAL/METERB. Multiplier 1.0
Units P I NSPECTION
Quantity
Fee Amount 62.1
Paid to Date
Fee Balance O
Contractor ID IQ
Prescribed by State 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
P Purchase Order No.
S5 F Si 2 Terms
.L Nu d y Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4 e S t2l U" 0�
Total
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
QM IN SUM OF
/9L) S� S'7
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or
DEPT INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
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
2 20 1
b g 6 ure
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund