1996, 11-26 Permit: 96010269 Gas Insert Refund PROJECT NUMBER= 96010269 DUPLICATE DATE= 11/26/96 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 13005 E ALKI AVE PARCEL#= 45153.0711
ADDRESS= SPOKANE WA 99216
PERMIT USE= GAS LOG, & PIPING
PLAT#= 000000 PLAT NAME= UNKNOWN
BLOCK= 2 LOT= 9 ZONE= AGSUB DIST#= F
AREA= 00000000 F/A= F WIDTH= DEPTH= R/W=
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST =
OWNER= BOMBEN, ANGELO & MARGARET PHONE= 509 922 2171
STREET= 13005 E ALKI AVE
ADDRESS= SPOKANE WA 99216
CONTACT NAME= CHIM-CHEER-EE PHONE NUMBER= 509 324 9223
BUILDING SETBACKS : FRONT= NA LEFT= NA RIGHT= NA REAR= NA
******************************* MECHANICAL PERMIT *****************************
CONTRACTOR= CHIM CHEER-REE PHONE= 509 467 2324
STREET= 6196 N CEDAR RD #103
•
ADDRESS= SPOKANE WA 99208
ITEM DESCRIPTION QUANTITY FEE AMOUNT
PROCESSING FEE Y 25. 00
GAS LOG OR GAS INSERT 1 10.00 • .
GAS PIPING 1 1. 00
******************************* PAYMENT SUMMARY ****************************
PAYMENT DATE RECEIPT# PAYMENT AMOUNT
11/20/96 00012497 36.00
TOTAL DUE= .00 TOTAL PAID= 36.00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
MECHANICAL PRMT 36.00 36. 00 .00
36.00 36. 00 .00
PROCESSED BY:' CAROL FRAZIER � 1
PRINTED BY: JOELL WANDS g43-g0 (gQ 1p> To Pa
LI
******************************** THANK YOU *************** ** * k * ** ****
REFUND
PV# 7lV14V40VVJ7
Dept ..,n eeD E :;"ORCE
VENDOR:
CHIM CHEER -REE
6196 N CEDAR RED ::103
SPOKANE WA 99208
Vendor ContacVrel
FOB:
ACCTG. PERIOD: 12/96
LGFS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
SHIP TO: BILL TO:
Confirming Order
PO DATE:
DELIVERY DATE:
FNTF.RF.D BY, PAT
80% CANCELLEDIPRJx96- 10269
SITE: 13005 E. ALKI. AVE.
SPOKANE WA 99216
01 406 030 0008
REF FIVIN CERTIFICATION
Mat nals n in q mity V have been
recei ed i d co iti.n or contr ted for.
SIGNE
TITLE A CT ECH I I I
DATE 12/03/96
BLDGIROOM:
WAREHOUSE:
A EICKSTADT
2216' X37
BUYER
PV
Change Order#
Bid ID
Blanket#
RC #_
VI #_
MN12G250039
OtNALD L. LA6
2,S *30
PAGi:
TOTAL:
2808;
DISCOUNT
TOTAL:
O +OU
FREIGHT
TOTAL:
0.00
SALES TAX
TOTAL:
0.00
PURCHASE ORDER
VALUE:
28.80
USE TAX
TOTAL:
0000
GRAND
TOTAL:
28.8^.
28.80
TOTAL TO VENDOR: 28.8?::
T ERTIFICATIO TRAVEL CERTIFICATION
the undersig o hereby certify unde penalty of perjury that sufficient funds have been budgeted for this claim, the I hereby certify under penalty of perjury that this
m vials have bee rnished, services re ered or labor performed as described herein or contracted for, that the claim is is a true and correct claim for necessary expenses
a jus du end unpw bligation against pokane County or fund agency indicated above, that I am authorized to authenticate incurred by me and that no payment has been received
nd cc ' y to said by me on account thereof.
SIGNED TITLLOFFICE ADMINISTRATOR SIGNED TITLE
12 / 0
DATE 3 / 9 6 DATE PAGE
-
ACCOUNTS PAYABLE
1