Ref_Req-To.Finance.8.5.10.pdfDate:
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`Iltil III l� I III I A
Leonard Lutes
555 Main St.
Edmoinds, WA 98020
SIM
Receipt Number: Pa went: REC051238 Refund: REC05,1412
OriginaHy Receipted in Account E - Street Use Permit Fee — 300C $85,
X -Permit Surcharqe Fee- 200-1155
(Pern-dt Trax Fee IN & Description)
Permit/App NumberE 20100233
Reason for Refund- Permit not need
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Approved by:
Robert S'.'Eng (ish, P.E. Dale
City Engineer
City of Edmonds czR Community Services
DATE: Monday, August 02,20M
12.1 5 1 H AVENUE NORTH - EDMONDS WA 98020
PHONE (425) 771-0220 - PAX: (425) 771-0221
PERMIT #: ENG20100233
PROJECT ADDRESS: 555 MAIN ST, EDMONDS
PROP OWNER: LEONARD LCJTE
555 MAIN ST
EDMONDS, WA 98020-
(425) 614-9163 Nx .
*FURY:
Date
Description
Fee Amount
Paid
Balance Due
6/l/2010
f: -Street Use Permit Pee
$85.00
($85.00)
$0.00
6/1/20 i 0
X -Perm it Surcharge Fee
$15.00
($15.00)
$0.00
7/6/20 0
F -Street Use Permit Pee
(585.00)
$85.10
$0.00
7/6/200
X-PermitSurcharge Fee
(515.00)
$1.5:00
$0.001
Total Due: SOA0
SO.00
SO.00
*FFES JRF FSTRIATE!) B ISFT) ON INF[9R114TIOAT PRC)1'JDE J ,gid 7' SCflirl ITTAT,-SUTd NC"T TO C FI2sVGE
Date Reeeipt# Method/Payee
Paid
6/.1/2010 RF 051238 Auto/Leortard A Lutes
($100.00)
X -Perm t Stn -Charge FCC
($15.00)
E -Street Use Pe nit FCC
($85,00)
7/6/2010 REC051.412 Refund/
$100.00
-Pernvt Surcharge FCC
$1.5,00
E -Street Use Peru it FCC
$85.00