1997, 07-31 Permit App: 97005638 Gas Log, PipingMECHANICAL PERMIT APPLICATION
PROJECT' ADDRESS' . / 0/ S Y%1 Cw7�
OWNER: `,/I/(Litt)
MAILING ADDRESS:
CONTRACTOR: �'7-. ((' •
PHONE, DAYTIME CONTACT
O l(B• ti.P
city/state)
(street)
(.'
%27-1(1439
(rips)
LICENSE: 2c< i :' : :` / 7
UNLISTED APPLIANCE (ADDITIONAL CHARG
UNLISTED APPLIANCE (ADDITIONAL CHARC
USED APPLIANCE (Must meet WSEC's min. AFU
USED APPLIANCE (Must meet WSEC's min. A
BOILE;J' FRIOETION
BOILER/REPRIOERATION
BOILER/REFRIGERATION
BOILER/REFRIGERATION
$Z• BOILER/REFRIGERATION
BI31GAS LOG GAS INSERT. A
BI°RANGE
BIIDRYER
B INFUEL BURNING WA
BI MISCELLANEOUS F
B23 AIR HAN • ' • • :
. s v. (DO include duc
OTE: MIN
SIGNATU
Spokane County Departnent of Building & Planning
1026 W. Broadway • Spokane, WA 99260
Tel. No. (509) 456-3615 • Fax No. (509) 324 j0$! TDD No. (:,',09) 324- 166
Spokane Cowry don not diacfmin$lEOTh a lasia of disabilitg ,{Jla admission to, ur treatment or cmployment in. lu program or set
toile emminbil
PLEASE MAKE CHECKS PAYABLE TO:
SPOKANE COUNTY PERMIT CENTER
G a Pnn�t r: IQ
Date
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bpn p,, WA 99206
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Time:
FAX:
Phone
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„ REFUND
Pv# MV080470005
Dept 030 BUILD E PLAN
VENDOR:
FALCO STOVE SHOP
9310 E SPRAGUE AVE
SPOKANE WA 99206
Vendor ContacVrel
LGFSaPAYMENT DOCUMENT
SPOKANE COUNTY•AUDITOR
BIDL TO:
SHIP TO:
FOB:
ACCTG. PERIOD:
COMMENTS:
COMM LN#
Confirming Order
08/97
PO DATE8
DELIVERY WAREHOUSE:
ENTEREDBY. AT$:Z.C;FAA :ICICS`TADT
COMMODITY NO
BUYER
PV MV080470005
Change Order #
BM ID
Blanket#
RC#
VI#
PURCHASING DIRECTOR: DONALD L. LABRECQU
REF ACCT LINE`. 'OUANTITY I UNIT I • UNIT 1T: -‚'TOTAL
80%. CANCELLED,PRJ::97-5638
SITE: 11615 E MAIN AVE
SPOKANE WA 99206
28.80
PAGE TOTAL: 28.80
DISCOUNT TOTAL: 0.00
FREIGHT TOTAL: 0.00
TAX TOTAL:
PURCHASEES ORDER VALUE: 0.00
8.80
USE TAX TOTAL: 20.00
GRAND TOTAL: 28.80,
LINE NO. 1 FUND 1 AGCY I ORG 138 ORG I ACT 1 OBI I SB OB1 I REV SRC I 38 REV I RPT CAT IBS ACCTI 108 NO. I PAY THIS AMOUNT
1 P/F
01 406 030 0008 2210 07
28.80
REL EI V i ..__ _.M1`ICATION PAYMENT CERTIFICATION
Ma t cels noyI to quantity / have been 1, 1 undersig in hereby reg mtd(r penalty of perjury that sufficient funds hate been budgeted for this claim, the
:ern ed mAd co non or contracted for mate Is hate been ithed, centres rens ered or labor performed as described herein or contracted for, that the claim is
iiGNEeiFi/�L%ie a Just, a and unpai� \ ligation against SWI kane County or fund agency indicated nbnve, that I am outbadzed to authenticate
and carbo oidd e-
ITLE
)ATE
ACCT TECH 3
08/05/97
SIGNED --
DATE 08/05/0
TITLE OFFICE ADMINISTRATOR
ACCOUNTS PAYABLE
TOTAL TO VENDOR: 28.80
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 TITLE
DATE
PAGE
1