HomeMy WebLinkAboutPERMIT REFUND FORM 121323Revised 07/2008
PERMIT REFUND FORM
]DATE: �cer- 8 � t 3
I,
representing o�� �MTSSOiti
request a refund for
permit number
Type of Refund
issued to job address f'
dated u Z
for the amount of $_ Zo 5. o o My reason for requesting this refund is:
Signature
REFUND TO:
Address: Z G D 14,VC
City, State, Zip:
AA
*FOR OFFICE USE ONLY*
Project Address: e°V-0
4
Permit Number:
Type of Refund
Amount Charged:$ 7.45. op Less Administrative Cost: $
Total Refund: $ S °
From Account umber:
Approved By:
UTTLt, -
City of Little Rock
Planning and Development
Filing Fees
Date 10-09
Annexation
Board of Adjustment
Cond Use Permit/T UP
Easement Abandonment
Final Plat
Planned Zoning Dev
Preliminary Plat
Special Use Permit
Rezoning
Right -of -Way Abandonment
Site Plans
Street Name Change
Street Name Signs
Number at ea
Public Hearing Signs
Number 1 at 5 ea
File No Z-9859
Location 15 Java Court
Applicant John Hintson
By Debra Stafford
20 23
PLANNING & DEVELOPMENT
Na
$
$
$
S
S 200
S
S 5
Total $ 205
OCT 0 9 PAID
CITY OF LITTLE ROCK
BUILDING CODE