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20111025082517460.pdf
REFUND REQUEST ........ . .................... . .... Date: '10/24/11 Mailing Address,: Richard Kirschner 7503 Braemar Drive Edm*n4s. Wl 98020 Vendor ; 073847 Amount of Refund: 1 Ci Payment Receipt Number: REC053629 Refund Receipt Number:.— REC054197 Originally Receipted in Account Right of Wav Permit -- ----- — (Permit Trax Fee ICS & Description) Permit/App Number: eng201110213 Reason for Refund: Scope of work changed -inspections not needed Requested by: JoAnne Zulauf ZMEEM Robert S. English, P,E, City Engineer City of Edmonds Community Services F - 0 D MON"],-.)S 121 5T1-1 I` UE I"��ORTfl - EL)1twiCiNDS AVENUE 1D20 r � PHONE: (42.5) 771-0220 -� FAX: ('425) "7WA 9871-022.1 DATE: Monday, October 17, 201 1 PERMIT #.: E 6201 10213 PROJECT ADDRESS: 7620 201ST ST S W, ED1v1ONDS PROP OWNER: 7503 BRAEMARDRIVE EDMONDS, WA 98020 (425) 745-1944 (Date (Description Fee. mount fair! Balance Due 7/19/2011 E -Right of Way Permit Fee $185.00 ($185.00) $01,00 7/19/2011 E -ROW Restoration $60.00 $0.011 $60.(111 7/1.9/2011 X -Permit Surcharge Fee $15.00 ($15.00) $0.00 7/1912011 Fee (Q."CY: 1') $601.00 $0.00 $60.00 10/17/2011 F-€~<eCund Inspection Pee (Q'lY 1) ($60.00) $0.00 ($60.00) 1 0/1 7/2011 E -Refund Inspection Pee (QTY: I ) ($60.00) $0.010 ($60.00) `total Dane. $200.00 ($200.00) $0.00 *FEES ARE ESTIA11ATFD f1,4SFD ON1.NP'C7RA111TION PIiOKIDED AT SUBAIITIrIL-SUBJECT TO CHANGE PA'1'MENT'1'18 ANSACTIONS: Date Receipt 4 Method/Payee 7/19/201.1 RECO 53629 Auto /Richard X11 Kirschner X -Permit Surcharge Fee E -Right of Nay Permit Fee E -Engineering Inspection Fee E -ROW Restoration Paid ($320.00) ($15.00) ($185,00) ($60.00) ($60.00) 10/1.7/2011 REC054197 Refund / $1.20.00 E -Engineering Inspection Fee $60.00 E -ROW Restoration $60.00