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Existing /A N
Date:
Name of Bu iness/Person Pa ing: •
Project Name:
Project Address:
APN No.(s)
Purpose:
AMOUNT ($)
- kcaxropireo1
ENGINEERING DIVISION
TRUST & AGENCY REVENUE TRANSMITTAL
0014-7z-
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Verified by:
Amount: $ 24� /( e�/-�
Engineering $toff Name:
01 V/T-g7�41f-4
IU7-7'024s
I'/'no vlc° e sen,d
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ACCOUNT #
#726-1141
Others:
DESCRIPTION
Trust & Agency Deposit
REFUND PAYABLE TO: (if applicable)
Name & Address /jam 011a-hVe, -2 07- re5virL
%Inns, 839 & Ca td s7 z, Inc///2
I certify under the penalty of law that the information submitted is to the:best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including
the possibility of fine and imprisonment for knowing violations.
Print Name
Engineering Permit No.
REFUND Date:
Final Inspection Date:
Amount Refunded: ($)
The sum shall be in the nature of a de osit only and as an advance against the obligation of the
developer to pay the city for maps, puUlic improvements, private grading i plans, inspections,
NPDES reviews, and any expenses provided for under city ordinances.
8
Rev. 07/01/10 J
.......... ,rrr•ur•NRPPONAy_'`OPTY°•••••••.....
Finance Department
619 "336-4330
National City 39 / 38008
01/04/2011 07:44:43.000 Reg WXPCASHF1
Validation Receipt
CHARGES-
001-06029-3142
EG GRADING PERMITS $ 396.00
001-06029-35.85
GF2135 MISC. USER CHARGES$ 490.00
726-1141
726114 001474-innovative $ 2000.00
001-06029-3144
TRANS HOUSE MOVING PERMI$ 476.00
Sub -total $*******3362.00
PAYMENT -
Check - 1069 $ 3362.00
innovative
Change **********
$ 0.00
THANK YOU!
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