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Ref_Req-To.Finance.8.5.10.pdf
REFUND REQUEST Date: 8/4/10 Mailing Address: Alan G. Kausal 17718 68tAve W Edmonds, WA 98026 Vendor#: #073350 Amount of Refund: $110.00 Originally Rec:eipted in Account: E -Sewer Permit Fee #115 $35,00 E-Eng�neerinq Inspection #305A $60 X -City Surcharge #200 $15 (Rermit Trax «d\-&& ID# & Description) Refund to be Paid from Fund(s): 411.000.000.322.900.000.00 $35 001.000M0.343200,000M $64: 001 M0.000.321.930.000.00 $15 Reason for Refund: Sewer repair was not nect&saw — Vog perm b, Requested by: JoAnne Zulauf Approved: Robert S. En/ & P.E. bate City Engineer City of Edmonds czq Community Services wil wil 1. DATE. Wednesday, August 04„ 2010 121 5TH AVENUE NORTH - F D1+, ONDS,41?,A 98020 PHONE: �(425) 771-0220 - FAX: (425) 771-0221 PERMIT##: El'sG20100196 PROJECT ADDRESS: 1711.8 68TH AVE W, EDN1ONDS PROP OWNER: AL.ANGKAUSA1, 17118 68'r1I AVE W EDMONDS,, WA 98026- (425) 741-3391 E.A. ' FEE S UMMA Y - Date Description Fee Amount Paid Balance Due 5/4/2010 E-Engincering Inspection Fee $60.00 ($00.00) $;0.00 5/4/2010 E-Se\wr Permit Fee $35.01) ($35.00) $0.00 5/4120/0 X -Perm it Surcharge Fee $ l 5.00 ('.$1.5.00) $0.00 &x"3/2010 E -Sem. -r Permit Fee ($35.00) $35.600 $0.00 8/3./2010 X-PermitSurchargeFee ($15.00) $15.00 $0.00 8/3/2010 E-Engineeriing Inspection Fee ($60.00) $00.00 $0.00 Total Due: 60.00 50.00 50,00 *F'FrSARE I"STIh,I4TFl) BASED ON INP-ORAIIATION PROVIDED AT SIIBAWTTAL-SUBJECT TO CHANGE PA v1 T'Tl3ANSAcr[ONS: Date Receipt # Method/Payee Paid 5/4/2010 REC051106 Ruta/Ala ° usal ($110.00) E,Sewver Permit Fee ($35.00) X -Permit Surcharge Fee ($15.00) E -Engineering Inspection Fee ($60.00) 8/3/2010 R X051582 Refund/ $110.00 F,rSevwer Pemit Fee $35.00 X-Penuit Surcharge Fee $15.00 E -Engineering Inspection Fee $60.00