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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