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Receipt.pdf
OF E ram CITY OF EDMONDS 1215TH AVENUE NORTH - EDMONDS, WA 98020 I PHONE: (425) 771-0220 - FAX: (425) 771-0221 �. 1 g9 DATE: Monday, September 21, 2015 PERMIT #: ENG20140547 PROJECT ADDRESS: 22821 106TH PL W, EDMONDS 22821 106TH PL W EDMONDS, WA 98020 * FEE S UNIMARY: 10/29/2014 E -Sewer Permit Fee - New 10/29/2014 E -Engineering Inspection Fee (General) 10/29/2014 X -Permit Surcharge Fee 08/25/2015 X -Permit Surcharge Fee VOID (QTY: 1) 08/25/2015 E -Sewer Permit Fee - VOID (QTY: 1) 08/25/2015 E -Engineering Inspection Fee (VOID) (QTY: 1) Total Due $90.00 $0.00 $90.00 $180.00 $0.00 $180.00 $25.00 $0.00 $25.00 ($25.00) $0.00 ($25.00) ($90.00) $0.00 ($90.00) ($180.00) $0.00 ($180.00) $0.00 $0.00 $0.00 *FEES ARE ESTIMATED BASED ON INFORA1IATIO N PRO VIDED AT SUBMITTAL -SUBJECT TO CHANGE PAYMENT TRANSACTIONS: 10/29/2014 REC061788 AUTO 08/25/2015 REC064227 REFUND Jim Dandy Enterprises Inc. / AUTO PAY - TRN: 635328 / OVW SD - VOID PERMIT ($295.00) $295.00