1998, 03-17 Permit: 98001749 RefundREFUND
Pv# 1 A
Dept _ PLAN
VENDOR:
COURCHAINE EXCAVATIN
16402 E VALLEYWAY
VEPADAL-
Vendor Contact/fel
WA 99038
SHIP TO:
LGFS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
Confirming Order
BILL TO:
PV ,MV031E30013
Change Order #
Bid ID —
Blanket#
RC#
VI#
FOB:
ACCTG. PERIOD: 03/98
COMMENTS:
PO DATE:
DELIVERY DATE:
ENTERED BY:
80%, CANCELLED, PRJ:t98-1749
SITE: 1319 N. Elton Rd.
SPOKANE WA 99212
DIST: "F"
PAGE TOTAL:
DISCOUNT TOTAL:
FREIGHT TOTAL:
SALES TAX TOTAL:
PURCHASE ORDER VALUE:
USE TAX TOTAL:
GRAND TOTAL:
28.00
28.+00
0.00
0. 0 C.
0.00
28.00
0.00
28.00
01
RECEIVI
aterials
ive
SIG
TITLE
DATE
406
ERTIFICATION
in quanti J have been
condi `. or contracted for
ACCT ECH 3
03/17/98
PAYMENT CERTIFICATION
1, the under gned do hereby certify under
materials h e bee furnished, services ren
a just, du: d un id obligation against S
and certify said laim.
SIGNE
DATE
.e fly of perjury that sufficient funds have been budgeted for this claim, the
• ,d or lab erformed
erformed as described herein or contracted for, that the claim is
', me Co of or fund agency indicated above, that 1 am authorized to authenticate
./// ASSISTANT BUILDING
��`;� ING DIRECTOR
03/17/98
A('(`C I INTB PAYABLE
TOTAL TO VENDOR:
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
DATE
TITLE
PAGE
1
SPOKANE COUNTY DIVISION OF BUILDING AND PLANNING
1026 W: BROADWAY • SPOKANE, WA 99260-0050
(509) 456-3675
SITE INFORMATION PROJECT INFORMATION
SITE ADDRESS: 1319 N ELTON RD
SPOKANE WA 99212
PARCEL NUMBER: 45182.0601
SUBDIVISION: BASCETTA'S ADD.
LOT: 1 BLOCK: 1 ZONE: UNKN
INSPECTOR: FRANK PALADICHUK
WATER DIST:
OWNER: BEYER, H. LOUISE
PHONE: 509 926 3351
ADDRESS: 1319 N ELTON RD
SPOKANE WA 99212
PLUMBING PERMIT
CONTRACTOR
BESTWAY PLUMBING
LICENSE #: BESTWP*088MT
WATER PIPING - DWV 1
PROCESSING FEE 25.00
MINIMUM FEE ADJUSTMENT 4.00
TOTAL PERMIT FEE $35.00
7. c� Jo°(o
PAYMENT SUMMARY
PAYMENT DATE RECEIPT# PAYMENT AMOUNT
03/11/98 00002165 $35.00
TOTAL FEES AMOUNT PAID AMOUNT OWING
$
-------------
35.00 $35.00
$.00
DUPLICATE BY: CAROL FRAZIER
�.� i 4-vl- --; �-(L
PROJECT NUMBER: 98001749 ISSUE DATE: 03/11/98
PERMIT USE: PLUMBING REVERSAL
APPLICANT: COURCHAINE EXCAVATIO
PHONE: 509 924 5485
ADDRESS: 16402 E VALLEYWAY
VERADALE WA 99037
CONTACT: COURCHAINE EXCAVATIO PHONE: 509 924 5485
SETBACKS -> FRONT: NA LEFT: NA RIGHT: NA REAR: NA
LENDER NAME:
PHONE:
ADDRESS:
PERMIT(S)
ey- fv�;4- C
NOTEs
(�-) [' (q2l-