4. INITIAL DETERMINATION REQUEST PAB-0190.PDF
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MARICOPA COUNTY DEPARTMENT OF TRANSPORTATION 2901 W. Durango Street e Phoenix, AZ 85009 Phone: (602) 506-4178 Applicant Name: lila pura Mailing Address: G20 L/ ZT, Yao : . City: w/AVE State: » OL. Z Zip: Zz HP Phone 20d). 367-4 Lee ematt: /AP Ltavey Z Gitiitd lin Assessor's Parcel Number: 230. OF. ‘O31 A 1. Location of Request: (ex: 3200 W. Dove Valley Road, Phoenix) Bab WN I lty Plute,, Wiha We GID 2. Description of Request: (ex: Abandon Easement bordering the South side of parcel 123-45-067A) Ablow. Eliervnt on WS Site CL LM Y Of Larlo/ 2207 07- DILA = C (Sh 0h VRE ET =P TI, lEnge¢r 3. Access Certification: I certify, under penalty of perjury, that no loss of currently existing legal and physical access to any property will occur if the County grants the patent easement abandonment requested in this initial determination. Signature of Applicant Date’ PAB Number: Initial Determination Fee*: $250.00 ui Total Received: BASD-2> ate: /SMM-202/ pects By: Be-.| * The Initial Determination fee is NOT refundable, Make checks payable to: MCDOT 2901 West Durango Street Phoenix, x) 85009. eck #: Maricopa County Department of Transportation 2901 W. Durango Street Phoenix, AZ 85009 Permit Receipt Payer Name: Receipt #: 100823 TARA PARRY Payment Date: 11/15/2021 826 N 111TH PLACE Reference #: APN 220-07-031A MESA , Arizona 85207 Receipt Type: Patent Easements Payment Items Description Payment Type Transaction # Amount PATENT EASEMENT ABANDONMENT INITIAL Credit Card 3818183202 $250.00 DETERMINATION / TARA PARRY Total: $250.00 Met jeopa Caunty Department of Wansportation MCDOT Permits Thank you for your payment. Please print this receipt and keep it for your records. Cletk ID: BPEREZ Customer Name: = TARA PARRY Reference Number : APN 220-07-031A Product Description Payment Amount $250.00 Payment Amount: $250.00 Patent Easements 4 Receipt Number: 3818183202 Transaction Date: 11/15/2021 09:16 AM CY mber: *2140 x v7? Uf} J agree to pay this obligation according to the terms oullined in my agreament with my card issuer.