1999, 09-02 Permit: 98011761 RefundVendor ID HENDROOF
Woucher ID 00007352
Rel Vchr ID
Dept ID Building and Planning
VENDOR:
Henderson Roofing, Inc
1003 S Pines Rd
Spokane WA 99206
SPOKANE COUNTY PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
SKIP TO:
BILL TO:
PAGE 2 OF 2
RC#
INV# 98-11761
cn(lor Contact/Tel
ENTERED DATE: 09/01/1999 PO DATE: BUYER:
ENTERED BY: Patty Eickstadt PURCHASING DIRECTOR: BELA G. KOVACS
LINE NO. I DISTRIB LINE _ ACCOUN I FUND ORG I IPROGRAM SUB -CLS RPT CAT B. YR PC UNIT PAY THIS AMOUNT
PROJECT I AC IVITY I RES.' TYPE `» CATEGORY .SUB CAT I AM UNIT I PROFILE I ASSET.FLG ASSET ID
DISCOUNT TOTAL: .00
FREIGHT TOTAL: .00
SALES TAX TOTAL: .00
SUBTOTAL: 78.19
USE TAX TOTAL: .00
GRAND TOTAL: 78.19
Comments: SITE: 13814 EMISSION AVE TOTAL TO VENDOR: 78.19
SPOKANE WA 99206
PRJ# 98011761
RECEIVING CERTIFICATION
Materials noted in quantity " have been received in good condition or
contracted for.
1
SIGNED
DATE 9/2/99 TITLE ACCT TECH 3
PAYMENT CERTIFICATION
I, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted
for this claim, the materials have been furnished, services rendered or labor performed as described
herein or contracted for, tt the claim)is a just, due and unpaid obligation against Spokane County
or fund agency indicated av�. tha� iam authorized to authenticate and certify to said claim.
SIGNED
DATE 9/2/99 TITLE OFFICE ADMINISTRATOR
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
DATE TITLE
Vendor ID HENDROOF
•VoucnerlD 00007352
Rel Vchr ID
Dept ID Building and Planning
VENDOR:
Henderson Roofing, Inc
1003 S Pines Rd
Spokane WA 99206
SPOKANE COUNTY PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
SHIP TO: BILL TO:
PAGE l OF 2
RC#
INV# 98-11761
Vendor Conwct/Tel _
ENTERED DATE : 09/01/1999 PO DATE: BUYER:
ENTERED BY: Patt Eickstadt PURCHASING DIRECTOR: BELA G. KOVACS
LINE NO. DESCRIPTION INV ITEM ID UANTITY UNIT UNIT PRICE EXTENDED AMOUNT
-- —
PO# CHG' ORD), PO LINE# PO SCHED# CONTRACT#
1 80% CANCELLED, PRJ# 99011761 t.uuuu >GA i�.oy •"'
0 0
2 STATE SURCHARGE 1.0000 EA 4.50 4.50
0 0
LINE NO. > DISTRIB LINE ACCOUNT FUND ORGPROGRAM SUB -CLS RPT CAT B. YR PC UNIT' PAY THIS AMOUNT
PROJECT ACTIVITY RES.' TYPE CATEGORY SUB CAT I AM' UNIT I PROFILE ASSET FLG ASSET ID In
1 1 221002 406 0300008 iyyy ricv�r�
DOBP 240 REFND N
2 1 23700 N20 1999 4.50
N
1;b t Lnsert Records Window /jell) •
1E0E3
z , • A
ettincip
Type RetUnd
__..1.31Pt4 I Er°IeCt ACCtla011anCe
1
Otispiaal Refund Refund
IsmI_
I t Acc"nt ' AMOUtit '. ., ''''•.Foo " .' Invoice FlPkInd
Type Description Nit ,,A,,.nt,,.. ' . Amount Percent
, BU RESIDENTIAL PMTS 892.11 892.11 892 11 80.0
1 Y 111.1 STATE SUFI CI IAFIG E 84.50 t4.50 84 50 100.0
Refund
Amount
873.69
84.50
Total Refunded: 878.19
Doc ID: RECPT813211 Expiration Date:
Reason: 80Z, CANCELLEDPRJ0 98011761
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lehr 2473 Notes 110%,CANCEL40,,,,PRJOSSOI
Tear:rip PEickste
'..• , , 1,,-...j Date/Time tr,Latic...zzign User ID PEicksta Tran Type: Refund
harscarsliso Petal- -,',7:, .,•;.;.,..: TenekrAomanek•
"
Pro j / Comm Inv Acct Desc Tr 'Arist • '
Type ,s.,•".., Doc ID Tender
98011761 2 RESIDENTIAL PMTS (1/ "I'," •I
K Ch‘ackl RECPT11132 1$78.191
98011781 2 STATE SURCHARGE 437.50B9I
Net Tendered: (578.19)
Total Projects: (*7819)11
Change:
80.00
Net Tendered: (87019)
1
Total Mize:
Reason: 811Z. CANCELLED PIUS 98011781
Iran 0 ver/(S hortj:
Net Transaction: (570_19)
RIECOd ILL
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Form View
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SPOKANE COUNTY DIVISION OF BUILDING AND PLANNING
I ` 1026 W. BROADWAY • SPOKANE, WA 99260-0050
(509) 456-3675
SITE INFORMATION
Site Address: 13814 E MISSION AVE
Spokane, WA 99206
Parcel Number. 45151.0819
Subdivision: VERA
Zoning: B-1 Neighborhood Business
Owner: WARD, JOE
Address: 13814 E MISSION AVE
SPOKANE, WA 99216-2762
Inspector: BOBBY STONE
Water Dist:
PROJECT INFORMATION
Project Number: 98011761 Inv: 1 Issue Date: 11/18/98
Permit Use: RE -ROOF DUPLEX
Applicant: WARD, JOE
Phone: (509) 000-0000
Address: 13814 E MISSION AVE -
SPOKANE, WA 99216-2762
Contact: WARD, JOE Phone: (509) 000-0000
13814 E MISSION
SPOKANE, WA 992
Setbacks - Front: Left: Right: Rear:
PERMIT(S)
Building Permit Contractor: OWNER License #: OWNER
Remodel RE -ROOF R-3 VN 0 RESIDENTIAL VALUATION $75.50
Dim: \ StoriesSTATE SURCHARGE $4.50
Total Value: $2,600.00
Sq Ft: RESIDENTIAL SURCHARGE $16.61
Total Permit Fee: $96.61
`iao
_9i .I
1 v
�LL PAYNI I �\T SU,,tNLkRI' '�',�- I�}`� Page of 1 NOTES 1
COPY By: BURRIS. ROBIN � °I� -v;,,
Tran Date Receipt # Pavment Amt
11/18/98 13211 596.61 { 50 6C
Total Fees AmountPaid AmountOwina )�•�C�, )f)1L '� )
$96.61 J96.61 X0.00
1
-FUN"'
PV4,4 MV041 ")97,1)
Dept
PLAN
VENDOR: SHIP TO:
WART? J,-3 CE.
missi7N AV --
S P 0 K A,',!!--
VESP0KA^,l._ WA 99215
Vendor Contact/Tel
LGFS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
Confirmina Order
BILL TO:
PV MV0141290055
Change Order#
Bid ID
Blanket#
RC#
95-11751
VI#
FOB:
PO DATE:
BLDG/ROOM: BUYER
ACCTG. PERIOD: )4/99
DELIVERY DATE:
WAREHOUSE:
COMMENTS:
ENTERED BY: PATRICIA
EICKSTAOT PURCHASING DIRECTOR: B E L A G. K V A C S
COMM LN#
DESCRIPTION
COMMODITY NO
REF ACCT LINE
QUANTITY UNIT UNIT PRICE TOTAL PRICE
8)"? CANCELLED PRJ::98-11' 11
SITE: 13814 E MISSION AVE
SPOKANE WA 99206
1 30 C'0":a
-`2 N2 07
%10 '2
PAGE TOTAL:
VISCOUNT TOTAL:
FR`_IGHT TOTAL:
SALES TAX TOTAL:
PURCHASE ORDER VALUE:
USE TAX TOTAL:
GRAND TOTAL:
RECEIVIN CERTIFICATION PAYMENT CERTIFICATION
M enals n in qua [i y ✓ have been I, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted for this claim, the
rec ved i cond i nor contracted to materials have been furnished, services rendered or labor performed as described herein or contracted for, that the claim is
a just, a an aid obliga 'on again Spokane County or fund agency indicated above, that I am authorized to authenticate
SIGNE and ce! if o said im.
TITLE SIGN TITLE OFFICE ADMINISTRATOR
DATE 4/13/99 DATE 4 13 99
-1700
TOTAL TO VENDOR:
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
?3.59
4.50
78.19
0.00
0.00
O.00
73.19
0.0o
7-3.19
73.F9
4.5:
7.19
PAGE
1