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Level 3-CS130220
Y K C • C I T Y • 0 F COFFELL RIGHT-OF-WAY MAINTENANCE USE FEE Ordinance No. 2001-944, Sec. 6-14-3. Registration Form for Service Provider Registration expires March 1 of every other year after the calendar year in which the first registration occurs. If registration is not renewed by the expiration date, after written notice from the City, the facilities of the service provider will be deemed to have been legally abandoned. Service Provider(include any business name provider operates under or has operated under for past 5 years)Leve/3 Ca nrnun%caf ons,Znc ©ocke f A% /BS 98 0441/2/98 PUC Certificate Number(for certificated telecommunications providers)poll) .5PCOA A/o 60/60/ City of Coppell License Ordinance No. Contact Names/Numbers Craig Bur's - C5'° Eny:neec - e/e/-4/y3-2752 or 2/y-'/35 3298 ce/t Contractor(s)Name ?U/ure TeVecoe 2.7c• — Imes Sc...orfris Contact Information Projecf Mar r - 97e 877- 94/0? Emergency Contact Cra/J, Qurr7s - /eve,/ 2/1/ '4/35 3'$'8 Liability Insurance Carrier Tave Jeri Z c via Ao, R/S4 iii Svcs (Sec. 6-14-3 (h)) Prone 866-&33-7/22 CGLit".476GSA76B9P//BTIG'Z Attach proof of coverage Plans of Record provided to Engineering Dept. for existing facilities ✓ Y N For proposed facilities N Forward registration form and fee to Engineering Dept., City of Coppell, 255 Parkway Blvd., Coppell TX 75019 For office use Only 0 / 2 D /Zo/3 Registration Fee of$250.00 paid 2 Receipt No. ©P 2 5c1/ Bank of America TECH GROUP&ASSOCIATES ACH R/r 111000025 924 WINDBELL CIRCLE STE A 972-613-0881 MESQUITE, TX 75149 2/19/201 PAY TO THE City of Coppell ORDER OF I $ "'250.00 Two Hundred Fifty and 00/100********* «.***,«***** ****..*,A*«*.** *********************** « «, ************.t City of Coppell MEMO fees "P' �� __ •RIZED SIGN• URE 000 36 30 f: L L /0000 2 5I: 4880 3 38 . ?86n■ TECH GROUP&ASSOCIATES City of Coppell 2/19/2013 Date Type Reference Original Amt. Balance Due Discount Payrr 2/19/2013 Bill 250.00 250.00 25C Check Amount 25C CASH RECEIPT Date ■20I3 082591 Received From au 88 Address ®2 A ® LL STE.11 Q o b v m 4 /HE S a?"Lf; X 7, / g "' 3�' g For- R-0-W >r Dollars$ /f j ao�i V N U ACCOUNT HOW PAID AML ONF Bank� ACCOUT 5 U AMT.PAID ° 1,'.�X CHECK BALANCE /�� v®O M REDI7 CARDO BY ® /c ®/. :,,