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2003, 06-27 Permit: 02010430 RefundVoocher ID 00193580 Vendor ID DIAMROCK Invoice # PRJ # 02-10430 Dept ID VENDOR: Diamond Rock Construction Dennis Crapo 15321 E Mission Ave Veradle Vendor Contact/Tel WA 99037 SPOKANE COUNTY PAYMENT DOCUMENT SPOKANE COUNTY AUDITOR SHIP TO: BILL TO: PAGE 1 OF 2 Rel Vchr RC# ENTERED DATE : 06/27/2003 PO DATE: ACCTG. PERIOD: 06/2003 LINE NO. DESCRIPTION PO# ENTERED BY: Patty Eickstadt ITEM ID QUANTITY BUYER: PURCHASING DIRECTOR: BELA G. KOVACS UNIT UNIT PRICE CHG ORD# PO LINE# PO SCHED# EXTENDED AMOUNT CONTRACT# 1 2 3 4 5 Bldg's Residential portion 80% Crrnt Ping's Residentail porti Mechanical portion of refund Plumbing portion of refund State Surcharge 0 0 0 0 0 0 0 0 0 0 0.0000 0.0000 0.0000 0.0000 0.0000 0 0 0 0 0 0.00 0.00 0.00 0.00 0.00 618.46 246.52 67.20 72.00 4.50 LINE NO. DISTRIB <LINE ACCOUNT FUND DEPTID PROGRAM CLASS RPT CAT BDPER PC UNIT PROJECT ACTIVITY RES. TYPE CATEGORY SUB CAT AM UNIT PROFILE PAY THIS AMOUNT ASSET FLG 1 BACE 2 CPLAN 3 BACE 4 BACE 5 1 240 1 6030 1 240 1 240 1 221002 221002 221007 221003 23700 406 REFND 417 REFND 406 REFND 406 REFND N20 0300008 4170000 0300008 0300008 2003 2003 PROJA PROJA 2003 PROJA 2003 PROJA N N N N ASSET ID, 618.46 246.52 67.20 72.00 4.50 Voucher ID 00193580 Vendor ID DIAMROCK Invoice # PRJ # 02-10430 Dept ID VENDOR: Diamond Rock Construction Dennis Crapo 15321 E Mission Ave Veradle Vendor Contact/Tel WA 99037 SPOKANE COUNTY PAYMENT DOCUMENT SPOKANE COUNTY AUDITOR SHIP TO: BILL TO: PAGE 2 OF 2 Rel Vchr RC# ENTERED DATE : 06/27/2003 PO DATE: ACCTG. PERIOD: 06/2003 ENTERED BY: Patty Eickstadt BUYER: PURCHASING DIRECTOR: BELA G. KOVACS 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 Comments: 80% = Refunded for permit # 02-10430 = Jurisidiction is now in the new City of Spokane Valley Applicant changed mind and new permit was issued in the City of Spokane Valley. SITE LOCATION: 619 S. LONG RD.; SPOKANE WA 99???? DISCOUNT TOTAL: FREIGHT TOTAL: SALES TAX TOTAL: SUBTOTAL: USE TAX TOTAL: GRAND TOTAL: TOTAL TO VENDOR: 0.00 0.00 0.00 1008.68 0.00 1008.68 1008.68 RECEIVING CERTIFICATION Materials noted in quantity have been received in good condition or contracted for. SIGNED 6/27/03 ACCT TECH 4 DATE TITLE PAYMENT CERTIFICATION I, the u for thi herein e claim, the materials o rs certify under penalty of perjury that sufficient funds have been budgeted ve bee claim is aju I am au contracted for, that th ndicated a metund,age fished, services rendered or labor performed as described due and unpaid obligation against Spokane County zed to authenticate and certify to said claim. SIGNED DATE 6/27/03 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 Project Receipt Summary Friday, Jane 27, 2003 Page 1 of l Address 619 S LONG RD PROJECT#: 02010430 Owners Name: CRAPO, DENNIS Phone: (509) 924-8964 Address: 15321 E MISSION AVE.; VERADALE, WA 99037 Occupant: Phone: Applicant: CRAPO, DENNIS Phone: (509) 924-8964 Use: RESIDENCE W/GARAGE - NATURAL GAS*** Cancelled 6/27/03 pap*** Application Date: 11/20/2002 Permit Issue Date: 12/3/2002 Receipt Nbr: 9585 Transaction Date/Time: 12/3/2002 10:42:59 AM Acct Account Transaction Description Total Due Amount Paid 00150 STATE SURCHARGE P $4.50 $4.50 E0002 ENGR-APP PERMIT P $10.00 $10.00 P0120 RESIDENTIAL PMTS P $308.15 $308.15 00610 PLUMBING PMTS P $90.00 $90.00 00410 MECHANICAL PMTS P $84.00 $84.00 00120 RESIDENTIAL PMTS P $773.08 $773.08 E0003 ENGR-APP INSPECT P $20.00 $20.00 $1,289.73 $1,289.73 Tender Type Checkl Receipt Nbr: 4112 Amount Paid Payer $5,716.58 DIAMOND ROCK CONSTRUCTION, INC Transaction Date/Time: 6/27/2003 5:29:17 PM Acct Account Transaction Description Total Due Amount Paid 00150 STATE SURCHARGE R $0.00 ($4.50) 00610 PLUMBING PMTS R $0.00 ($72.00) 00120 RESIDENTIAL PMTS R $0.00 ($618.46) 00410 MECHANICAL PMTS R $0.00 ($67.20) P0120 RESIDENTIAL PMTS R $0.00 ($246.52) $0.00 ($1,008.68) Tender Type Amount Paid Payer Checkl ($1,008.68) Amount refunded w/pps voucher # 00193583 — site location is the City of Spokane Valley's jurisdicition. FROM : Interstate Professional Plaza 15321 E. Mission Ave Veradale, WA 99037 ! De, /2(-5 FAX NO. : ICON °'( K ON 6-16-63 Jun. 16 2003 04:16PM P1 (509) 924-8964 Office (509) 926-8094 Fax o �l�ice Lf 71 -- 'Z 1 3 f t '17 7 y%03 Pie.45e e Gw per,}:4- We perms fled a 5ta/,` 4vsc 7/4 ,i -v,,,,_"1/4; q Com. re?..„ -ed � � spa lc. (Aitt,