1997, 06-03 Permit: 97003485 RefundREFUND
Pv# MV060270003
Dept n3n — TUJI D G
VENDOR:
PRO GAS
519 E CROWN AVE
SPOKANE
Vendor Contact/Tel
PLAN
WA 99207
SHIP TO:
LGFS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
lc
Confirming Order
BILL TO:
PV MV060270003
Change Order #
Bid ID
Blanket#
RC#
vI#
FOB: PO DATE: BLDG/ROOM: BUYER
ACCTG. PERIOD: 06/97 DELIVERY DATE: WAREHOUSE:
COMMENTS: ENTERED BY: PATRICIA E I C K S T A D T PURCHASING DIRECTOR: DONALD L s L A B R E C Q U
COMM LN#
DESCRIPTION
DIST 11 F"
COMMODITY NO
REF ACCT LINE
QUANTITY
UNIT
UNIT PRICE
TOTAL PRICE
80%, CHANGED CONTRACTORS
SITE: 2213 S. BURNS RD.
VERADALE WA 99037
PAGE TOTAL:
DISCOUNT TOTAL:
FREIGHT TOTAL:
SALES TAX TOTAL:
PURCHASE ORDER VALUE:
USE TAX TOTAL:
GRAND TOTAL:
29.bO
29.60
0.00
0.00
C1.OU
29.60
0.00
29.60
LINE NO.
01
FUND
406
AGCY
ORG
030 0008
SB ORG
ACT
OBI
SB OBJ
REV SRC
SB REV
RPT CAT
BS ACCT
JOB NO.
PAY THIS AMOUNT
P/F
CATION
certify under
, services ren
n agains
2210 07
nalty of perjury that sufficient funds have been budgeted for this claim, the
ed or labor performed as described herein or contracted for, that the claim is
okane County or fund agency indicated above, that I am authorized to authenticate
29.60
TOTAL TO VENDOR: 29.60
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.
TITLE OFFICE ADMINISTRATOR SIGNED TITLE
ACCOUNTS PAYABLE
DATE PAGE
1
SPOKANE COUNTY DIVISION OF BUILDING AND PLANNING
1026 W. BROADWAY • SPOKANE, WA 99260-0050
(509) 456-3675
SITE INFORMATION
SITE ADDRESS: 2213 S BURNS RD
VERADALE WA 99037
PARCEL NUMBER: 45261.2206
SUBDIVISION: VERA CREST
LOT: 6 BLOCK: 4 ZONE: AGSUB
INSPECTOR: FRANK PALADICHUK
WATER DIST:
OWNER: ANTLES, TOM
PHONE: 509 924 8151
ADDRESS: 2213 S BURNS RD
VERADALE WA 99037
PROJECT INFORMATION
PROJECT NUMBER: 97003485 ISSUE DATE: 05/27/97
PERMIT USE: GAS RANGE & (2) PIPING
APPLICANT: PRO GAS
PHONE: 509 484 5735
ADDRESS: 519 E CROWN AVE
SPOKANE WA 99207
CONTACT: RICK - PRO GAS PHONE: 509 484 5735
SETBACKS -> FRONT: NA LEFT: NA RIGHT: NA REAR: NA
LENDER NAME:
PHONE:
ADDRESS:
PERMIT(S)
MECHANICAL PERMIT
CONTRACTOR
PRO GAS
LICENSE #: PROGA**055DM
RANGE
GAS PIPING 2
1
PROCESSING FEE 25.00
TOTAL PERMIT FEE $37.00
A% 04 0
8e. e-Lete.
PAYMENT SUMMARY NOTES
PAYMENT DATE RECEIPT# PAYMENT AMOUNT
05/27/97 00004365 $37.00
TOTAL FEES AMOUNT PAID AMOUNT OWING
$37.00
$37.00 $.00
ISSUED PERMIT BY: JULIE SHATTO