1992, 06-25 Permit: 92003970 RefundVENDOR REFUND
CODE
NAME 'IFRRY 1711P FTT
ADDRESS >OU a ROAD
SPOKANE, WA 019206
NO.
FUND
SPOKANE COUNTY PAYMENT VOUCHER
INVOICE NOUMBER FUND AGENCY I IOZATION I ACT OBJ I OBJ SUB I SOURCE I REV { RE NUMBEJOB R f CATEG REPT I ACCT
80% REFUND U« ,r_"1RMIT 92-003970 FOR 16-1- .ju i - GLtG!.b
PROJECT CANCELED PER COPY OF PERMIT WITM NOTATION
ATTACHED l
ORGAN- SUB , ACTIVITY) SOURCE REVENUE I q(v I JOB NUMBER CATEG. J RACCONTS
IZATION I ORG
SELLER CERTIFICATION
. tiereby 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
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.
CERTIFICATION
SIGNED
TITLE -SCE ADMINISr '
DATE 6/25/92
DATE
AGENCY
NAME .09F FNP()RCF'
AUDITORS STAMP
❑ 1099 REO'D ID#
DESCRIPTION
AMOUNT
28.00
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
COUNTY DEPART MENT OF BU
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 istrue
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 sarne. Al! provisions of laws and ordinances governing this type of work will be complied with whether specified
herein or not. 1 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 provisionsof any state or local law regulating construction, or as a warranty of conformance with the provisions of any stateor local
laws regulating construction.
SIGNATURE OF
APPLICATION
OWNER OR AGENT s DATE
FVii_ A ....