1995, 02-28 Permit: 95001027 Plumbing Fixtures, ReversalSPOKANE COUNTY DEPARTMENT OF BUILDINGS
WEST1O26 BROADWAY • SFoicANE, WA 99260-0050
(509) 456-3675
SITE INFORMATION
PROJECT INFORMATION
SITE ADDRESS: 1609 S CLINTON ST
SPOKANE WA 99216
PARCEL NUMBER: 45271.1812
SUBDIVISION: OPPORTUNITY TERRACE
LOT: 12 BLOCK: 4 ZONE: UR -3.5
INSPECTOR: REED OCKEY
WATER DIST:
OWNER: LEWIS, DON
PHONE: 509 924 4777
ADDRESS: 1609 S CLINTON ST
SPOKANE WA 99216
PROJECT NUMBER: 95001027 ISSUE DATE: 02/28/95
PERMIT USE: PLUMBING REVERSAL, TOILET, SINK, & SHOWER
APPLICANT: MUELLER JACKHAMMER I
PHONE: 509 534 7143
ADDRESS: 3628 E 32ND AVE
SPOKANE WA 99223
CONTACT: MARC MUELLER PHONE: 509 994 5697
SETBACKS -> FRONT: N/A LEFT: N/A RIGHT: N/A REAR: N/A
LENDER NAME:
PHONE:
ADDRESS:
PERMITS
PLUMBING PERMIT
CONTRACTOR
OWNER
LICENSE #:
PROCESSING
rOILETS/BIDETS
1
;HOWERS
1
;INKS
1
IATER PIPING - DWV
1
FEE
25.00
IDTAL PERMIT FEE
$49.00
F
PAYMENT SUMMARY
NOTES
PAYMENT DATE
RECEIPT#
02/28/95 00001367
PAYMENT AMOUNT
$49.00
TOTAL FEES AMOUNT PAID AMOUNT OWING
$49.00
S49.00 $.00
ISSUED PERMIT BY: BURRIS, ROBIN
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Pv#
Dept
VENDOR
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Vendor Contact/Tel
92
SLS TO:
LGFS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
BDAJ TO:
SYSTEM VOID
Confirming Order
Change Order #
Bid ID
Blanket#
RC#
vI#
FOB:
ACCTG. PERIOD:
COMMENTS:
PO DATE:
DELIVERY DATE:
ENTERED BY.
BLDG/ROOM:
WAREHOUSE:
COMM LN#
DESCRIPTION
BUYER
PURCHASING DIRECTOR -
COMMODITY NO
REF ACCT LINE
QUANTITY
UNIT
+ -95 CLINTON-P4OJECT CANCELED - 80% REFUND
$49.00 X 80% _ $39.10
UNIT PRICE
PAGE TOTAL:
OI$CJUNT TOTAL:
FREI",HT TOTAL:
SALES TAX TOTAL:
PL,RCHAE 3RDEii VALUE:
uS E TAx TOTAL:
TOTAL PRICE
3 .2C
J.00
•x•00
000
3 .20
0.00
UNE NO.
FUND f AGCY t ORG
SB ORG { ACT
OBI
SB OBI
REV SRC
SB REV 1 RPT CAT
BS ACCT
IOB NO. 1 PAX THIS AMOUNT
P/F
RECEIVING CERTIFICATION
Materials noted in quantity ! have been
received in good condition or contracted for.
SIGNED
TITLE
DATE 3/3/95
ACCT TECH 3
PAYMENT CERTIFICATION
1, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted for this daim, the
materials have been furnished, services 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 indicated above, that I am authorized to authenticate
and certify to said daim.
SIGNED TITLE
DATE 3/3/)5
(RECTOR
DEPARTMENT 2
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 received
by me on account thereof
SIGNED TITLE
DATE PAGE