1993, 12-13 Permit: 93010429 RefundPv#
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lendor Contact/Tel
LGFS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
SHIP TO:
Confirming Order
SILL TO:
Change Order #
BILI ID
Blanket#
I#
FOB:
ACCTG. PERIOD:
COMMENTS -
'
PO DATE:
DELIVERY DATE:
F.NTF.RF.D BY
BLDG/ROOM:
WAREHOUSE:
BUYER
PURCHASING DIRECTOR.
CO
M LN#
DE
Pilot;
CO OD 'Y NO
REF ACCT LINE
QUANTITY
UNIT
UNIT PRICE
TOTA
LICE
$49.(.0 f11) X 30%
11316 E. FAIR`IIEW AVENUE - PROJECT CANCELED - 30% REFUND
$39.20
GINE NO,
FUND
AGCY
ORO
SB ORO 1 ACT
OBI SB OBI 1 REV SRC SB REV I RPT CAT
BS ACCT 1 JOB NO.
S AMOUNT
P!1'
RECEIVING CERTIFICATION
Materials noted in quantity / have been
received in good condition or contracted for.
SIGNED �.. ��Y' � 14L%F'
TITLE t f .' '.1 t.,{�
DATE
PAYMENT CERTIFICATION
I, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted for this claim, 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 1 am authorized to authenticate
and certify, to said claim.
SIGNED TITLE
DATE
DEPARTMENT2
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 TITLE
DATE
PAGE
SPo C DEPARTMENr of BUILD
,,f WA 260-00 0
�iW�ST+�.026�BROADWAY =; • SPOKANE, 99 5
SITE INFORMATION
PROJECT INFORMATION
SITE ADDRESS: 11316 E FAIRVIEW AVE
SPOKANE WA 99206
PARCEL NUMBER: 45092.1204
SUBDIVISION: FAIRACRES REPLAT #2
LOT: 4 BLOCK: 2 ZONE: UR -3.5
INSPECTOR: STEVE HOLYK
WATER DIST:
OWNER: CARPENTER, CARL & PAT
PHONE: 509 924 5483
ADDRESS: 11316 E FAIRVIEW AVE
SPOKANE WA 99206
PROJECT NUMBER: 93010429 ISSUE DATE: 10/28/93
PERMIT USE: GAS FURNACE, WATER HEATER, & PIPING
APPLICANT: KTU OF SPOKANE
PHONE: 509 467 4000
ADDRESS: 000088 E WESTVIEW
SPOKANE WA 99218
CONTACT: KTU OF SPOKANE
PHONE: 509 467 4000
SETBACKS -> FRONT: NA LEFT: NA RIGHT: NA REAR: NA
LENDER NAME:
PHONE:
ADDRESS:
YERMIT(S) ,
MECHANICAL PERMIT
CONTRACTOR
K T U OF SPOKANE
LICENSE #: KTUSPI*153MA
1AS APPLIANCE<=100,0008 1
iAS WATER HEATER 1
IAS PIPING 2
PROCESSING FEE 25.00
TOTAL PERMIT FEE $49.00
C
PAYMENT SUMMARY
NoTEs
PAYMENT DATE
RECEIPT#
10/28/93 00012172
TOTAL FEES
PAYMENT AMOUNT
$49.00
AMOUNT PAID AMOUNT OWING
$49.00 $49.00
ISSUED PERMIT BY: CAROL BRADBURN
$.00
• PLUMBING • HEATING • ELECTRICAL
"keit &me in, Skeice"
Spokane County
Department Of Buildings
W. 1303 Broadway
Spokane, Wa 99260
The Customer Has Decided Not To Go With KTU On The
Washington Water Power Conversion Program. Please Refund
Ktu At Your Soonest Possible Conveniences Thankyou.
Sincerely,
KTU
EAST 88 WESTVIEW • SPOKANE, WASHINGTON 99208 • 467-4000 • Contr. Lic. KTU SPI 153 MA