1997, 12-16 Permit: 97008480 RefundPv#
Dept
REFUND
MV121570005
PLAN
VENDOR:
SIDEL,STEVE E HENTHORN,
2E09 E 8TH AVE
SPOKANE
Vendor Contact/Tel
JUNE
WA 9920,.'.
SHIP TO:
LGFS PAYMENT DaCUMENT
.--SPOKANE COUNTYPFiifIDITOR
1 1 Q-
f:u—iillrudnu (Who
FOB:
ACCTG. PERIOD: 1 2 / 97
COMMENTS:
PO DATE:
DELIVERY DATE:
ENTERED BY:
BILL TO:
BLDG/ROOM:
WAREHOUSE:
PATRICIA EICKSTADT
BUYEII
PV MV121570005
Change Order #
Brd ID
Blanket#
VIII
PURCHASING DIRECTOR: DONALD L. LABB EC0UE
• COMM1N# •
DESCRIPTION
r.
ti
COMMODITY NO
REP'ACCT LINEA -"
`QUANTITY
UNIT "
UNIT PRICE
TOTAL PRICE'''
80;y CANCELLED, PRJ:797-8480
SITE:
DIST: 'F11
1209 N FELTS RD
SPOKANE WA 99206
PAGE
DISCOUNT
FREIGHT
SALES TAX
PURCHASE ORDER
USE TAX
GRAND
TOTAL:
TOTAL:
TOTAL
TOTAL
VALUE
TOTAL:
TOTAL:
4.50
97.60
102.10
0.00
0.00
0.00
102.10
0.00
102.10
LINE NO.
FUND
AGCY
ORG
SB ORG
ACT
OB1
SB OBI
' REV SRC
SB REV
RPT CAT
BS ACCT
10B NO.
PAY•THIS AMOUNT
P/F
01
n 7
N20
406
675
030 0008
2420
2210
02
3700
TOTAL TO VENDOR:
4.50
97.60
102.10
RECEIVIN
Malenals n
ed In
ERTIFICATION
quanta J have Men
oTlmo ror contracted
SIGNED
TITLE
DATE
17/16/97
PAYMENT CERT ICATION
1, the&und arse geed doby certify under penalty of perjury that sufficient funds Kase ban budgeted for this claim, the
materials hale been turn bed, services rendered or labor performed as described herein or contracted for, that the claim is
�a Just, due and unpa d'nhl jtloI against Spokane County or fund agency Indicated above, that 1 om authorized to authenticate
and rtlfy to said clai, s�--
SIGNED N- '� TITLE OFFICE ADMINISTRATOR
DATE 12/16/97
TRAVEL CERTIFICATION
I hereby certify under penalty of perjury that this
Is a true and correct claim for necessary expenses
incurred by one and that no payment has been received
by me on account thereof.
SIGNED TITLE
DATE
PAGE
1
OIC . -T COUNTY DIVISION OF BUILDING AND PLANNING
1026 W. BROADWAY • SPOKANE, WA 99260-0050
(509) 456-3675
SITE INFORMATION PROJECT INFORMATION
SITE ADDRESS: 1209 N FELTS RD
SPOKANE WA 99206
PARCEL NUMBER: 45171.0803
SUBDIVISION: UNKNOWN
LOT: BLOCK:
INSPECTOR: FRANK PALADICHUK
WATER DIST: MOOERN
ZONE: UR -3.5
OWNER: SEIDEL, STEVE 8 HENTHORN, JUNE
PHONE: 509 534 4950
ADDRESS: 2609 E 8TH AVE
SPOKANE WA 99202
PROJECT NUMBER: 97008480 ISSUE DATE: 11/07/97
PERMIT USE: NEW DOUBLE WIDE MANUFACTURED HOME
APPLICANT: SEIDEL, STEVE 8 HENT
PHONE: 509 534 4950
ADDRESS: 2609 E 8TH AVE
SPOKANE WA 99202
CONTACT: JULIE SHEPARD - OAKW PHONE: 509 892 1774
SETBACKS -> FRONT: 31 LEFT: NA RIGHT: 15 REAR: NA
ENDER NAME:
PHONE:
ADDRESS:
PERMIT(S)
MOSILEHOME PERMIT
CONTRACTOR
OWNER
LICENSE #:
INSPECTION FEE 2
COUNTY SURCHARGE
STATE SURCHARGE
22.00
4.50
TOTAL PERMIT FEE $126.50
MISC FEES DUE
CONTRACTOR
OWNER
LICENSE #:
APPROACH INSPECTION
APPROACH PERMIT
di
TOTAL PERMIT FEE $30.00
?
=c/o cRet-tAeEd
1?oq��. ^614.1
4
avnLy
PAYMENT SUMMARY
NoTEs
PAYMENT DATE RECEIPT#
11/07/97 00011573
TOTAL FEES AMOUNT PAID
$156.50 $156.50
DUPLICATE
IPIi
PAYMENT AMOUNT
$156.50
AMOUNT OWING
BY: JULIE SHATTO
$.00
ij,se > Ll 020 (o75 3700
970 > . is -
Hca,1° 0 h