1992, 12-23 Permit: 92011147 RefundPv#
Dept
VENDOR:
Vendor Contact/Tel
SHIP TO:
EPS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
Cordsrrdng Order
BILL TO:
Change Order #
Bid ID
Blanket#
RC#
VI#
FOB: PO DATE: BLDG/ROOM:
ACCTG. PERIOD: DELIVERY DATE: WAREHOUSE:
COMMENTS. ENTERED BY:
COMM LN#
DESCRIPTION
BUYER
PURCHASING DIRECTOR.
COMMODITY NO
REF ACCT LINE
QUANTITY
UNIT
UNIT PRICE
TOTAL PRICE
107 NORTH FARR ROAD, SPOKANE, WA 99206
80% X 36.00 = $28.80
PAGE TOTAL:
LINE NO.
FUND t AGCY
ORG
SB ORG 1 ACT
OBI I SB OBI I REV SRC
SB REV
RPT CAT
BS ACCT
OB NO.
PAY THIS AMOUNT
P/F
RECEIVING CERTIFICATION PAYMENT CERTIFICATION TRAVEL CERTIFICATION
Materials noted in quantity 1 have been I, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted for this claim, the 1 hereby certify under penalty of perjury that this
received in good condition or contracted for. materials have been furnished, services rendered or labor performed as described herein or contracted for, that the claim is is a true and correct claim for necessary expenses
a just, due and unpaid obligation against Spokane County or fund agency indicated above, that I am authorized to authenticate incurred by me and that no payment has been received
SIGNED and certify to said claim. by me on account thereof.
TITLE SIGNED TITLE SIGNED TITLE
DATE DATE
DEPARTMENT
DATE PAGE
SPOKANE COUNTY DEPARTMENT OF BUILDING AND SAFETY
W. 1303 BROADWAY AVENUE
SPOKANE, WASHINGTON 99260
(509) 456-3675
I certify that I have examined this permit/application, state that the information contained in it and submitted by me or my agent to compile said permit/application is true
and correct, and authorize Spokane County to proceed with processing. In addition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE
provisions included herein and agree to comply with same. All provisions of laws and ordinances governing this type of work will be complied with whether specified
herein or not. I understand that the issuance of this permit/application and any subsequent inspection approvals or Certificates of Occupancy shall not be construed to
give authority to violate or cancel the provisions of any state or local law regulating construction, oras a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OF
OWNER OR AGENT
•
NuMBER= 92011
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SITESTREET= ,0.., N FARR Ft.:j •
AXJX11•!'I.. .. POI(AeJE WA 99206
PERMIT USE ;.;ria CLOTHES DRYER, PIP
i''I...i"iT:N::::: 001235 PLAT NAME..
BLOCK,. LOT
AREA= 00032000 El
: IiirlEI...I....I. r•
•
ONTAUI
ii.:»: i!• i:• :+' i • ii• * » * * * •3': ii• 3::,i..ii• ii ...ri.. 3,. :
APPLICATION
DATE
-
w:I:.. •fH= 100
F)
'ATF
PTH.,
..I fl t. 'r :::: 509 926 261 ..
ITEM :DI:::`:ORIF'T•:I:i.:)N
F:`R:C)rF::, SING NG F E E
a * * :,:..,.: )t 3 * jr .yj. 1t tt.3, * .. *Tri .. }r 3 aa*********
PAYMENT 1..1 r"I iii A f..,Y.
FEE AMOUNJ
f t.. r C::... n:
***a*** * :n..... )+ia)' 3i*)'. )t.3;..y '.)i.)+i)i ..)E•)i P:
TOTAL PAID=
AMOUNT PAID
............................................
36.00
36,00
PAYMENT r••ir'li}?iN
36,00
36,00
AMOUNT OWT.N.G
ii
34
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