1992, 10-26 Permit: 92007575 RefundSPOKANE COUNTY PAYMENT VOUCHER
VENDOR
CODE
NAME 9 RA ,UALITY HEATTW & ELF TP!r41. TAIL 1
ADDRESS ,:110 En' '`JEICE
"' SPOKANE, WA 0'?21
SUI REPT
NO. I INVOICE NOUMBER FUNDI AGENCY I IOZATION I ACT I OBJ I OBJ I SREVOURCE I REV NUMBER I C TEG I ACCT
I rr r _7575
1 100% RMM ON PERMIT #92-007575 FOR 8119 EAST GLASS AVE DUPLICATE
PERMIT PER CDPY OF PERMIT & #92-002356 ATTACHED
FUND `AGENCY{ DATION ORGI SUB ' ACTIVITY SOURCE REVENUE ' Rom JOB NUMBER + CATEG.
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the services SIGNED
rendered or the labor performed as described herein or contracted TITLE
for, and that the claim is a just, due and unpaid obligation, and that
I am authorized to authenticate and certify to said claim. DATE
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.
c�WICATION
SIGNED
r�
TITLE
10/26/92
DATE
EMM: MEf 131997
DATE 10/26/92
AGENCY
NAME rMF P_fTRrt Mf k T
AUDITORS STAMP
❑ 1099 REQ'D ID#
DESCRIPTION
AMOUNT
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
DATE 19
CHAIRMAN
MEMBER
MEMBER
Y SPOKANE COUNTY DEPARTMENT OF BUILDINGS
W. 1303 BROADWAY AVENUE
SPOKANE, WASHINGTON 99360 ~s
IcertifythatIhaveexaminedthis permit/application, state that the informatoOn�contained s� andsubmittedbymeormyagent to
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 w I be clomp) ed with/whether specified
herein or not. I understandgive authority to construcor tion.
el the provsonsthis ofanystat o�ocallon and lawregulatingconsubsest ucbouent n orasawarrantyofconformanc
laws regulating construction. approvals orCertificatesofOccupancyshallnotbeconstruedto
e with the provisions of any state or local
SIGNATURE OF
OWNER OR AGENT APPLICATION
DATE
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