2002, 11-04 Permit: 02004165 RefundVoucher ID 00161986
Vendor ID PAULDONI
Invoice # PRJ #02-4165
Dept ID
VENDOR:
Paulus, Donita
8021 E Grace
Spokane
Vendor Contact/Tel
WA 99212
SPOKANE COUNTY PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
SHIP TO:
BILL TO:
PAGE 2 OF 2
Rel Vchr
RC#
ENTERED DATE : 11/01/2002
ACCTG. PERIOD: 11/2002
LINE NO.
PROJECT
DISTRIB LINE
PO DATE:
ENTERED BY: Patty Eickstadt
ACCOUNT
ACTIVITY
FUND
DEPTID
PROGRAM
CLASS
BUYER:
PURCHASING DIRECTOR: BELA G. KOVACS
PC UNIT PAY THIS AMOUNT
RPT CAT
BDPER
RES. TYPE
CATEGORY
SUB CAT
Comments: 100% VALUATION ADJUSTMENT DIFFERENCE REFUNDED = PRJ # 02-4165 SITE
LOCATION: 8021 E. GRACE, SPOKANE WA 99212.
AM UNIT
PROFILE
ASSET FLG ASSET ID
DISCOUNT TOTAL:
FREIGHT TOTAL:
SALES TAX TOTAL:
SUBTOTAL:
USE TAX TOTAL:
GRAND TOTAL:
TOTAL TO VENDOR:
0.00
0.00
0.00
30.50
0.00
30.50
30.50
RECEIVING CERTIFICATION
Materials noted in quantity • have been received in good condition or
contracted for.
SIGNED
11/01/02
DATE
SIGNED:
IITTF• //_ [J •-A 2. TITLE:
PAYMENT CERTIFICATION
1, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted
have been furnished, services rendered or labor performed as described
claim is a just, due and unpaid obligation against Spokane County
v t I am authorized to authenticate and certify to said claim.
for this cla m, the ma
herein or contracted thatfor,
or fund agenc indicated abo
SIGNED
DATE
c�-
11/01/02
ASSIST. TO CEO
TITLE
OFFICE ADMINISTRATOR
TRAVEL CERTIFICATION
1 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
DATE TITLE
Voucher ID 00161986
Vendor ID PAULDONI
Invoice # PRJ #02-4165
Dept ID
VENDOR:
Paulus, Donita
8021 E Grace
Spokane
Vendor Contact/Tel
WA 99212
SPOKANE COUNTY PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
SHIP TO:
BILL TO:
PAGE 1 OF 2
Rel Vchr
RC#
ENTERED DATE : 11/01/2002 PO DATE:
ACCTG. PERIOD: 11/2002 ENTERED BY: Patty Eickstadt
ITEM ID
LINE NO.
DESCRIPTION
BUYER:
PURCHASING DIRECTOR: BELA G. KOVACS
QUANTITY
UNIT
UNIT PRICE
EXTENDED AMOUNT
PO#
CHG ORD#
PO LINE#
PO SCHED#
CONTRACT#
1
2
BACE'S PORTION OF VAL. ADJSTMN
0
CRRNT PLANG'S PORTION
0
0
0
0.0000
0.0000
0
0
0.00
0.00
21.81
8.69
LINE NO.
DISTRIB LINE
ACCOUNT
FUND
DEPTID
PROGRAM
CLASS
RPT CAT
BDPER
PC UNIT
PAY THIS AMOUNT
PROJECT
ACTIVITY
RES. TYPE
CATEGORY
SUB CAT
AM UNIT
PROFILE
ASSET FLG
ASSET ID
1
BACE
2
CPLAN
221002
406
240 REFND
221002 417 4170000
6030 REFND
0300008
2002
PROJA
2002 PROJA
N
21.81
8.69
rrojeui r-eueINt oui 111c1Iy
Address 8021 E GRACE AVE
Owners Name:
Address:
Applicant:
Use:
PAULUS, DONITA & JAMES
8021 E GRACE AVE
SPOKANE, WA 99212
Occupant: Phone:
PAULUS, DONITA & JAMES
2 STORY RESIDENCE ADD & ATTACHED GARAGE & EGRESS WINDOW
Friday, November 01, 2UU2 rage t o/
PROJECT#: 02004165
Phone: (509) 891-6496
Phone: (509) 891-6496
Application Date: 5/29/2002
Receipt Nbr: 3844
Acct Account Description
00610 PLUMBING PMTS
00150 STATE SURCHARGE
00120 RESIDENTIAL PMTS
00410 MECHANICAL PMTS
P0120 RESIDENTIAL PMTS
Tender Type
Check1
Receipt Nbr: 8741
Acct
P0120
00120
Account
Description
RESIDENTIAL PMTS
RESIDENTIAL PMTS
Transaction Date/Time:
Transaction
P
P
P
P
P
Permit Issue Date: 5/30/2002
5/30/2002 12:35:26 PM
Total DueAmount Paid
$35.00
$4.50
$696.75
$35.00
$277.73
$1,048.98
Amount Paid Payer
$1,048.98 DONITA B. PAULUS
Transaction Date/Time:
Transaction
R
R
Tender Type Amount Paid Payer
Check1
11/1/2002 1:41:42 PM
Total Due
$0.00
$0.00
$0.00
$35.00
$4.50
$696.75
$35.00
$277.73
$1,048.98
Amount Paid
($8.69)
($21.81)
($30.50)
($30.50) AMOUNT REFUNDED PER VALUATION ADJUSTEMENT W/ PPS VOUCHER # 00161986.
Project Summary
Project #: 02004165 Address:
8021 E GRACE AVE.; SPOKANE WA 99212
Use:2 STORY RESIDENCE ADD & ATTACHED GARAGE & EGRESS WINDOW
Application Date: 5/29/2002 Permit Issue Date:
Zoning: UR -7
Fire District: FD 01
Owners Name: PAULUS, DONITA & JAMES
Address: 8021 E GRACE AVE SPOKANE, WA 99212
Occupant: Phone:
Applicant: PAULUS, DONITA & JAMES
Contractor Information
Building Permit OWNER
Mechanical Permit OWNER
Plumbing Permit OWNER
Parcel Number: 45072.3802
Phone: (509) 891-6496
Phone: (509) 891-6496
Phone:
Phone:
Phone:
5/30/2002
'.1
Inspection
7/1/2002
7/1/2002
7/19/2002
9/11/2002
10/8/2002
10/10/2002
10/23/2002
Note Summary
HEALTHDIST CONDITIONS 5/29/2002 4:10:10 sewage system designed for 2 bedrooms only.
RICT
Description
SETBACKS
FOOTINGS
GAS PIPING
FRAMING
FRAMING
FRAMING
PROGRESS
By
HUSFLOEN, BARRY
HUSFLOEN, BARRY
WEISBECK, DAVID W.
WEISBECK, DAVID W.
WEISBECK, DAVID W.
WEISBECK, DAVID W.
ERICKSON, ART
Status
APPROVED
APPROVED
INFORMATION ONLY
PARTIAL APPROVAL
CORRECTIONS REQUIRED
APPROVED
NO INSPECTION
PM
- ,
Person/Company
Project No.
Project name/address:
' . . ., , ,......
,71. ; C., i i ),/e--, /
requesting refund: Dorl--, 1.--a..._ ,:...a.._ yj LA Phone .-.- ; 1 - 4g.'t i ;-...."
_ ------, ;
e.. al i ,i
' •.4" - f f.,',"" .—.) Date Paid. '-/=-7--i i/J-"Q., PLUS Receipt ... :
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,..._ • -( L... .-.:•.,..„;,. AA‘,.--) //c=1,7._ • -,:ik.,,--:: - 1—
REFUND TO:
• ' I
Name. D 6 ii., .v.i.._., Pa...i_ .J...),.....1, -s
Address: , _ i 7-- cL-7-:,-1,.-
Reason for the refund (attach a copy of the land use appticaton or permit for
' )C .5.....) -_,1 ,S--..`„,,, --;-.....t."1...Gi.
documentation): — '----,,-- ---- ' •---- -----
"---4.--e,,, „C. I ,...2......e..... 6
v
,—..
.,...„ ..,_
- VALUALTION
REFUND CALCULATION
Fee Description .
Current Valuation ,
Valuation Amt Paid
' I ,_.) 7 '':
j
REVISED VALUATION CALCULATION (subaijat from current valuation) -;i -1 7 .27" .r
Fee Description
''-.) - ti
Revised Valuation Total
'Minus ( -) i . . .:
....,
Revised Amt Due
inus S ---
M -.
. ,
--: ,
mous (-) ,
Minus 5 i :
__-
_.
Minus (-)
-Minus (-)
Minus 5
Minus S . i .--.,--
,
i.
Minus (-)
Minus S
..-...
- , ) i / - - : '-'-.--,
Difference i l", ...,..) , ...- _-•
Difference in Valuation Amt . L.,.
Percentage .-
of Refund I /,, ' ,‘-i.
1 --- - ' '
Valuation Amount to Refund $ :-...--- ),-
Other Refund Description:
Amount Paid
Percentage
of Refund
Amount to
Refund
$
S
$
S
$
$
S
... .,
Total Amount of Refund $
.,..,, ,
--,:..-,;',---,:-:::-:-.-:"-:=.,:.::-:-.'T-:-'::::::---.::-::::-1:-:::,..,-,:::','..-7:: ;•-•'': ..'f5- - FiefUnd PitiCeiSiiig, --.."-:;7,1'-!
.':=2:::;.-=•f.:-:.---:-.--,;,.'4-::',..,..:::-'1::-i'Z;:f!.::-f.-::--,:-:.;:_.!::;.: i:::,-1,,g_ijr',-"...--:37--.:-':•
Office
Paid with Voucher
-
Administrator Approval \- Date
/ Batch Number ‘ ' '.---' (..„,C_- / - ' Dale Processed / / - / - C
Process Person:7\74.)ck _
SPOKANE COUNTY DIV OF BLDG & CODE ENFORCEMENT
1026 W BROADWAY AVE PWK -1 = SPOKANE WA 99260
(509) 477 3675 Phone
(509) 477 4703 Fax
-
Revised: 8/28/2002
Filed Under: BACE Refund Request Form xis
4