1991, 01-28 Permit: 90006065 RefundSPOKANE COUNTYll,,PAYMENT VOUCHER
VENDOR,
NA _X T II OF SPDKANF
ADDRESS 88 EAST WESTVIEW AVENUE
SPOKANE, WA 99218
1
1 80% REFUND ON PERMIT #90006065 FOR 4031 SOUTH FOREST MEADOWS
DRIVE - PROJECT CANCELED PER COPY OF REQUEST AND PERMIT
ATTACHED
80% X 53.00 = $42.40
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the services SIGNED
rendered or the labor performed as described herein or contracted
for, and that the claim is a just, due and unpaid obligation, and that TITLE
1 am authorized to authenticate and certify to said claim. DATE
116105
DATE 1/28191
AGENCY CODE ENFORCEMENT
NAME
AUDITORS STAMP
❑ 1099 REQ'D ID#
REFUND
I, the undersigned do hereby
certify under penalty of perjury
that sufficient funds have been
budgeted for this claim, the ma-
terials have been furnished, ser-
vices 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 I am autho-
rized to authenticate and certify
to said claim.
CA
DATE 1/28/91
42.40
42.20
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
EXAMINED and ALLOWED
CHAIRMAN
MEMBER
MEMBER
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
W. 1303 BROADWAY AVENUE
SPOKANE, WASHINGTON 99260
(509)456-3675
1 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, or as a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
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