ST0502B-CS160201 T H E • C I T Y • O F
COPPELL
x
A S
P.O.Box 9478•Coppell,Texas 75019•972-304-3679
Engineering/Enviromental Health
Name 1W jc7GIVi0 ne
Service Address L6TtSo z 0, kf'l,,oc —
PhoneeNumber Pitle--"NYWI... 1 . GN) ' •2te)
Date ` ' � Cash Check No.1 S0�
Service
Food Permit
Pool Permit
Waste Hauler Permit
Temp. Event Permit
Construction Inspection Fee ' 1 , �f �/
�
Roadway Impact Fee `/
ROW Use Permit
Street Cut Permit
1315
TOTAL q.20-2.
OIW
Received By
I
TISEO PAVING COMPANY 95875
DALLAS,TEXAS 75227-0040
DATE INVOICE NO. DESCRIPTION INVOICE AMOUNT DEDUCTION BALANCE
1/20/16 012016 COPPELL 432 . 00 432 . 00
DATE
CHECK > CHECK
1/25/16 NUMBER> 95875 TOTALS) 432 . 00 432 . 00
PLEASE DETACH THIS PORTION AND RETAIN FOR YOUR RECORDS.