1998, 01-30 Permit: 97009459 RefundPv#
Dept
REFUND
MVG125,'30012
VENDOR:
SPOKANE
C30
BUILD L PLAN
FIREPLACE
27 W BOONE AVE
SPOKANE
Vendor Contact/T.1
WA 99201
SHIP TO:
LGFS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
Confirming Order
BILL TO:
PV MVC12980012
Change Order #
Bid ID
Blanket#
RC#
VI#
FOB:
ACCTG. PERIOD: 01/98
COMMENTS:
PO DATE: BLDG/ROOM:
DELIVERY DATE: WAREHOUSE:"
ENTERED BY: PATRICIA EICKSTADT
BUYER
PURCHASING DIRECTOR: D G N A L D L • L A b R E C 0U E
COMMIS
^`•`COMMODITYNO"'''' REF ACCT LINE OUANTITY '
UNIT
UNTT PRICE
TOTAL PRICE
•
Dist: "C"
80% CANCELLED
SITE: 9701'
80%,CANCELLED,
DIST:"G"
tT 6'1
PRJ '•97-10658
W. Champion Ln.
PRJ:. 97-9459
Barker
Grenacres
elr
WA 99016
Cheney WA 99004
ris
PAGE TOTAL:
DISCOUNT TOTAL
FREIGHT TOTAL
SALES TAX TOTAL
PURCHASE ORDER VALUE
USE TAX TOTAL
GRAND TOTAL:
29.60
30.40
60.00
0.00
0.03
0.00
60.00
0.00
6G •00
LINE•N09
01
02
yN DKt
_CFUND--'x
406
406
'I'AGCY ORG
030 0008
030 0008
SB OR'G
ACT
2420
2420
68i.
SB OBI
REV SRC
2210
2210
SB REV' ,
07
07
RPT CAT
BS ACCT
•JOB NO.
TOTAL TO VENDOR:
PAY THIS AMOUNT• -
29.63
30.40
60.0:.
.. P/F.
RECEIVIN CERTIFICATION
Matenals n
receive
SIGNE
lTFLEACCT TE
DATE 01/30/98 •
/n quantity J have been
or contracted contracted a'
PAYMENT CERTIFICATION
1, the and rsigaed do hereby certify under penalty of perjury that sumcient funds hose been budgeted for this claim, the
materials ave been fur shed, services rendered or labor performed as described herein et contracted for, that the claim is
a just, . and stip Id • .11 atl galas' Spokane County or fund agency indicated above, that 1 am authorized to authenticate
and ce n'. to id j i ASSISTANT BUILDING &
SIGN'i 1 w•r�\ TITLE PLANK ;I'+: r RRC
-
DATE 01/30 8
ACCOUNTS PAYABLE
TRAVEL CERTIFICATION
1 hereby certify under penalty of perjury that this
is a true and correct claim for necessary expenses
incurred by me and that no payment has been recei,ed
by me on account thereof.
SIGNED TITLE
DATE
PAGE
)
aNT'Y iTISIM ,OSUA DING'•
1026W.:BRbADIvAY .& SPOKANE, WA 99266-0050,;,:.
(509)456-3'675
(
SITE INFORMATION
PROJECT INFORMATION
SITE ADDRESS: 618 S BARKER RD
GREENACRES WA 99016
PARCEL NUMBER: 55202.0629
SUBDIVISION: CORBIN ADD TO GREENACRES
LOT: 16 BLOCK: 28 ZONE: UR -3.5
INSPECTOR: LEONARD FLUNO
WATER DIST:
OWNER: .LIEDKE, L.
PHONE: 509 625 6000
ADDRESS: 618 S BARKER RD
GREENACRES WA 99016
PROJECT NUMBER: 97009459 ISSUE DATE: 11/06/97
PERMIT USE: GAS LOG, 8 PIPING (3)
APPLICANT: SPOKANE FIREPLACE
PHONE: 509 326 3788
ADDRESS: 27 W BOONE
SPOKANE WA 99201
CONTACT: SPOKANE FIREPLACE PHONE: 509 326 3788
SETBACKS -> FRONT: NA LEFT: NA RIGHT: NA REAR: NA
ENDER NAME:
PHONE:
ADDRESS:
PERMIT(S)
MECHANICAL PERMIT
CONTRACTOR
SPOKANE FIREPLACE
LICENSE #: SPOKAFP033KL
GAS LOG OR GAS INSERT 1
GAS PIPING
PROCESSING FEE
TOTAL PERMIT FEE
3
25.00
338.00
r ac Ci' — '1.6 3 019%
L o /c goy/o 10 be 4
PAYMENT SUMMARY
NOTES
PAYMENT DATE RECEIPT# PAYMENT AMOUNT
11/06/97 00011502
TOTAL FEES AMOUNT PAID
338.00
838.00
AMOUNT OWING
838.00 5.00
ISSUED PERMIT BY: CAROL FRAZIER
6, re rte j L
Lesvoir, ct7/e a'
VA,