HomeMy WebLinkAbout047-680-025BUTTE COUNTY PARKS DEVEWPHINT FBS CERTIFICATION FORM
CHICO AREA RECREATION AND PARK DISTRICT
Assessor Parcel Number(s)--o �
Property Owner
Project Location/Address LSC) A6
Subdivision �� M 1A V !-- . _ — Lot Number s)
Residential Development: (check one)
New Development _Alteration/Addition _Hobilehome(s)
Total Number of Dwelling Units I
_Non-Residentia
to Residential
0
Comment:
has complied with the requirements of Butte Co. Resolution No. 90-140 by
payment for _ dwelling units @ $1,189 for total payment of I
1`s'c
00
I �
CA presentative Date
PAID BY CHECK NO. REHARKS:
BANK N0. qo
PAID BY CASH
RECEIPT NO.
Distribution: White --Applicant Yellow --Butte Co. Building Dept.
Pink --CARD Golde d--fi r of �Rro�Buildi l 9� r.L
01/04/01 #_. 9.. ,,,
park.fec (form revised 11/90
2-7 C, cJ
Building
Dep`rtment Representative
Date
Chico Area
Recreationand
Park District(CARD) certifies that
-CAI
(Applicant
Name)
(Phone Number)
(Street Address)
cklr&
J:: �
(City)
(State) .
(Zip Code)
has complied with the requirements of Butte Co. Resolution No. 90-140 by
payment for _ dwelling units @ $1,189 for total payment of I
1`s'c
00
I �
CA presentative Date
PAID BY CHECK NO. REHARKS:
BANK N0. qo
PAID BY CASH
RECEIPT NO.
Distribution: White --Applicant Yellow --Butte Co. Building Dept.
Pink --CARD Golde d--fi r of �Rro�Buildi l 9� r.L
01/04/01 #_. 9.. ,,,
park.fec (form revised 11/90
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