1991, 01-28 Permit: 91000190 RefundVENDOR
CODE
SPOKANE COUNTY PAYMENT VOUCHER
NAME ELITE HOMES
C/O RONALD J. TASKEY
ADDRESS 216 CLIFF DRIVE
^E ^Y •,>l ";IA nQ204
_INE VENDOR
NO, I INVOICE NUMBER
"0190
FUND AGENCY ( IOZATION ACT YI OBJ I OBJ SUB} SOURCE I REV I NUMBEJOB R I
REPT BS
C TEG ACCT
PERMIT #91000190 ISSUED FOR EAST 14422 MALLON AVENUE
CHECK # 506 $797.02
PERMIT TOTAL 792.46
REFUND AMOUNT 4.5r,
PER COPIES OF PERMIT AND CHECK ATTACHED
FUND JAGENCV) IOZATION ORG GAN- I SUB I ACTIVITY ` SOURCE
REV
I JOB NUMBER 4 CATEG. I R ACi r.nl INT
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
110101
DATE 1 J `..'a•`
AGENCY
NAME CODE EN70RCFMFNT
AUDITORS STAMP
❑ 1099 REQ'D ID#
DESCRIPTION
OVERPAY!'^"T
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 -)FFTrF Af)MTNTCTRA1 R
DATE 1/28/91
AMOUNT
1.56
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
SPOKANE COUNTY DEPARTMENT OF BUILDINGS
t
W. 1303 BROAr�ZDWAY AVENUE
SPOKANE, WASHINGTON 99260
(509)456-3675.
1 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 is true
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 will be complied with whether specified
herein or not. I understand that the Issuance of this permit/applicationand any subsequent inspection approvals or Certificates of Occupancy shall not be construed to
give authority to violate or cancel the provisions of any state or local law reg I ti gonstruption,oras_ a warranty of conformance with the provisions of any state or local
laws regulating construction. /� ' "�� ` '
SIGNATURE OF Q/ LSC APPLICATION f�o'� b� i