1992, 05-28 Permit: 91008069 RefundSPOKANE COUNTY, PAYMENT VOUCHER 131902
-VENDOR RefundCODE
NAME
Cturm Nnatinn
ADDRESS ina Fact Tndliana Avnet to
GIN/ann. WA QQ21IR
DATE
5/28/92
AGENCY
NAME (.Mf<a Fnfnrramnt
AUDITORS STAMP
ACCOUNT DISTRIBUTION, ORIGINATING ENMITY
1AL
VOU
HER TYPES)
❑ 1099 REQ'D ID#
LINE
NO.
VENDOR
INVOICE NUMBER
FUND AGENCY
ORGAN-
IZATION
ACT
OBJ
SUB
OBJ
REV
SOURCE
SUB
REV
JOB
NUMBER
REPT
CATEG
BS
ACCT
DESCRIPTION
AMOUNT
1
91-006069
406
030
0008
2210
07
Refund
30.40
DETAIL DESCRIPTION
1 Ka for Penult #91-008069 for 1403 North Best Roadthe
per copy Of permit �
undersigned do hereby
c certify under penalty of perjury
TOTAL
30.40
and note attached - canceled.
that funds have been
project
sufficient
budgeted for this claim, the ma-
terials have been furnished, ser-
vices rendered or labor performed
as described herein or contracted
for, that the claim is a just, due
and unpaid obligation against
Spokane County or fund agency
TRAVEL CERTIFICATION
I 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 received by me
on account thereof.
SIGNED -- -
indicated above, that I am autho-
rized to authenticate and certify
TITLE
INTRA -GOVERNMENTAL
VOUCHER
to said claire.
DATE
'\
FUND
AGENCY
ORGAN-
iZATION
SUB
ORG
SELLERS
ACTIVITY
ACCOUNT
REVENUE
SOURCE
SUB
DISTRIBUTION
JOB NUMBER
RPT
CATEG
OFFSET
RECEIVABLES
I---_,�-,
EXAMINED and ALLOWED
�,
CERTIFICATION
DATE 19
•
SIGNED.
CHAIRMAN
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the services SIGNED
TITLE Office Administrator
_
MEMBER
rendered or the labor performed as described herein or contracted TITLE
for, and that the claim Is a just, due and unpaid obligation, and that
5/29/92
I am authorized to authenticate and certify to said claim DATE
DATE
MEMBER
11-20-91
6,479,
04*
E
n n
* 58,00
* 38.00
* 38,006
*0,00
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
W. 1303 BROADWAY AVENUE
SPOKAf1E, WASHINGTON 99260
(509) 456-3675
this permit/application, state that the information contained in it and submitted by me or my agent to compile said permit/application is true
Spokane County to proceed with processing. In addition, 1 have read and understand the INSPECTION REQUIREMENTS/NOTICE
d agree to comply with same. All provisions of laws and ordinances governing this type of work will be complied with whether specified
at the Issuance of this permit/application and any subsequent inspection approvals or Certificates of Occupancy shall not be construed to
cel the provisions of any state or local law regulating construction, oras a warranty of conformance with the provisions of anystateorloc,a1
PROJECT NUMBER= 91008069
APPLICATION
DATE
ISSUED PERMIT DATE= 11/20/9i . PAGE= 01
PERMIT INFORMATION
SITE STREET= 1403 N BEST RD PARCEL4- 145423113
ADDRESS- SPOKANE WA 99206
PERMIT USE= GAS EQUIPMENT Y., PIPING
PLAT4= CONVRT- PLAT NAME= CONVERTED CNTY DATA
BLOCK= LOT= ZONE- SFR DIST4= F
AREA- 0001i875 F/A= F WIDTH= 125 DEPTH= 95 f/W=
OF eLDGS= 4 DWELLINGS= 10 WATER DIST -
OWNER- MAUER, SCOTT
STREET- i,10"3 N EqEET RD PHONE-
• . •
ADDRESS- SPOKANE WA 99206
coNTACT NAME- SfURM HEATING PHONE NUMBER - .509 --"'" 1505
BUILDING SETBACKS: FRONT= N/A LEFT= N/A RIGHT= -/A REAR= N/A,
****************************** MECHANICAL PERMIT ************K************
ooNTRACTOR- STURM HEATING
STREET= 204 E INDIANA AVE
ADDRESS- SPOKANE wA 99207
PHONE= 509 325 4505
ITEM DESCRIPTION • QUANTITY FEE AmnuoT
PROCESSING FEE ? 25.00
GifS ivrf'„ Qi;:iP<i0c:'OTU 1 •i :7! . f,f:)
GAS PI.PI•NG t i .1..00
PAYMENT :UmMAPY
PAYMENT L'h,TE aEccirT.I., PAYmENT Amouor
/-20/Yi 53':iao . 7,8.00
TOTAL DuE., .00 TOTAL P11,1D=
PERMIT
i FEE AmOHNT AMOUNT PAID AmOUNr nwNG
MFcHANICAL PreilT 38,00 38.00 ,20
:8,00 3M0 .00
PROCEED WC. D8MJIROVICH, ROTiw
ppiNTE!) 00mi:rpov[cH,
aii,ki.A THANK you Ailiti,ALi/CrUAK.rii..k.rFikik.it..0t*Iv*