1999, 09-21 Permit: 99005300, 99005301 RefundVendor ID SHORHOME
Voucher ID 00009726
Rel Vchr ID
Dept ID Building and Planning
VENDOR:
Shorewood Homes, Inc.
3901 Schreiber Way
Coeur D' Alene ID 83815
Vendor Contact/Tel
SPOKANE COUNTY. PAYMENT DOCUMENT PAGE 1 OF 1
SPOKANE COUNTY AUDITOR
RC#
SHIP TO: BILL TO: INV# 99-5300; 99-5301
ENTERED DATE : 09/21/1999 PO DATE:
ENTERED BY: Patty Eickstadt
LINE NO. DESCRIPTION I INV ITEM ID
r,
PO#� �I> CHG ORD
1 100%, OVER PAID GN PERMITS
BUYER:
PURCHASING DIRECTOR: BELA G. KOVACS
QUANTITY
UNIT
PO LINE
0
1.0000
PO SCHED#
0
EA
UNIT PRICE EXTENDED AMOUNT
CONTRACT#
30.00
30.00
LINE NO.
. PROJECT
1
DOBP
Comments:
DISTRIB LINE
1
240
ACCOUNT
FUND
ORG
PROGRAM
SUB -CLS
RPT CAT
B. YR
PC UNIT
ACTIVITY
RES. TYPE
CATEGORY
SUB CAT
AM UNIT
36981
406 0300008
REFND
SITE: 19305—E—FLATtOCK LN
GREEN ACRES WA 99016
PROFILE
PAY THIS AMOUNT
ASSET FLG
ASSET ID
1999 PR01A 30 00
N
DISCOUNT TOTAL:
FREIGHT TOTAL:
SALES TAX TOTAL:
SUBTOTAL:
USE TAX TOTAL:
GRAND TOTAL:
TOTAL TO VENDOR:
00
.00
.00
30.00
.00
3000
3000
RECEIVING CERTIFICATION
Maerlals noted in guanine * have been received in whirl condition or
comraacd tor
SIGNED
(yr hrircer
DATE 9/21/99
PAYNIENT CERTIFICATION
1, the undersigned do hereb) certif., under wreak) of perjury that sol l icicut funds has a bcun bit Jge1ed
for this claim, the materials h:nc born furnished, services rendered or labor perinnned: s diem -died
\ \,
herein or ennttacted for, that the cl iru is a just, due and unpaid obligation against Spokane (bulla
•
or food :tore) indicated above, that I am an lowed to authenticate and certif., to caul Jamil.
SIGNED
TITLEACCT TECH 3 DATE9/21/99
TIIQKFICE ADMINISTRATOR
TRAVEL CERTIFICATION
her ab, aero f} miller Pon:Jt' or °trine 01410114
n a True and correct claim lur nese. era e41)1.11M,
incurred b) me and dial nn pm Siem las been ra.u.al
In our on :airman thereon.
SIGNED
DATE TITLE
Spokane County
Public Works Department
Divison o f •Building & Planning
Receipt
Receipt Number: 7988 Customer Number
Projects
Miscellaneous Items
Tender
Ptd(
l'rolectNbr JnvNbr Pee Amt Inv Anti OW1112 PAID Pmt
99005300 1 $1,053.98 $1,053.98 $1,053.98 $1,053.98
99005301 1 $100.00 $100.00 $100.00 $100.00 N_l
Total: $1,153.98 $1,153.98 $1,153.98 $1,153.98
TbtadPAID: $1,153.98
Type Check Acct Balance CC Nbr Exp Date TENDERED
Checkl 11769 1,183.98
Total TENDERED: 1,183.98
Over /(Short) $30.00
Change $0.00
Notes: approach removed from application
Tran Date / Time: 9/16/99 1:36:56 PM
11 r: PSchneid
Logon User: kcumming
WOOD HOMES INC.
3901 SCHREIBER WAY COEUR D'ALENE, ID 83815
(208) 665.9400
FOR THE
SUM OF:
PAY
TO THE
ORDER
OF
AL IL
THE Swill- 8'3
e
7 q - 67.20 l
) Cc (Pt- ,T)C l -0
MOUNTAIN WEST SAVINGS BANK F.S.B.
P.O. Box 1059
Coeur D' Alene, ID 83816-1059
92-7195/1231
!..:I 11J DATE
001176
AMOUNT 98
83•
„,o,acc,•n1_n1.nnnnn 50
AUTHORIZED SIGNATURE
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Typed Refund
geceipl Project 1 Acct [Balance
Receipt Qverage Refund
Rdrm/Or f P,rrfitr Nt
[/,g . /Recept/O:
Enter Number 7988
Date / Time: 9/119/99 1 .3656 I'M
(Jrrgri..•.rl Receipt /NhaerMan-
User ID P Schneid
Logon User: Scumming
Computes Name: I CIIMMING
livenede Una ID: If0119
Cashbox ID: 7
Cashbox Dale: 9/16/35 8:00:33 AM
Cuslumet Number:
Notes: approach ;cleaved Irom
application
liaeso#isrs- :__ _ __ ... _....
Drginal Overage: (030 001
Accept
Refund Amount- $30 00 Doc ID: P9800009726
Reason: OVERPAID ON PRMT'S 99-53001 99-5301 Seancel
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Pro ef/S Project Number 99005300 Dist: G :LEONARD FLUNG Site' 58705
P
Grana: _ f PNIIIec* Nana
Applicant I lila Adelson 1 Issgoico Status 1 Actions 1 Eces 1 tlileslones 1 [Conditions I Team
Inspections Payaerst Hiamy 1 Renewals I Characteristics 1 Event Log I Pliny
Receipt Nbr _ ... Tran Type Psymern Invoice Nbr 1 Transaction Date 9716991 =6:56 PM
Rel Rod 60: 3124 Notes approach removed Isom uuoticodon Teller 10 PSchneid
9 Trancactioo Delai
' Arpt NT- ^:shrJ Date/Tims 05025EMEIZIE Usa ID PSchneid Tran Type: Payment
1J ianOder lendrAaow& Ref:__.. 0124
Proj / Cora Inv Acct Desc Tian Amt J Type Doc ID Tender
990053101 1 141 IIIANICAL P0405 064.00 J K Che k1 11769 91.1193.911
99005300 1 PLUMBING PMTS 972.00
99005300 1 RESIDENTIAL PMTS 0913.40
99005301 1 RESIDENTIAL P1405 915.00
9141U1153f s1 1 WO; F SIIHCHARIW IS 50 r Net Tadem& 91.183.98
Total P.ajects: 91.153.98 I
— —_--'.— Change. 90.00
j
Net Tenderest 91.103.911
Total Misc: J Reason: approach removed Irnm application
1 ran Over/TS host): 930.00
• Nes 1ransact.on: 91.103.98
Raeesd: 11s1 j - I..I - a 1 trilled)
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