2002, 04-24 Permit: 02001188 RefundProject Receipt Summary Wednesday, April 24, 2002 Page 1 of 1
Address 14713 EMISSION AVE PROJECT#: 02001188
Spokane WA 99216
Owners Name: HOITINK, JOHN & MARION
Phone: (509) 924-4829
Address: 14713 E MISSION AVE
Total Due
Amount Paid
SPOKANE, WA 99216-1959
R $0.00
($87.58)
Occupant:
Phone:
($4.50)
Applicant: DREAM ROOM DESIGN
Phone: (509) 922-7388
($34.91)
Use: 10 X 10 SUNROOM ADDITION" 4/24/02 Cancelled pap"'
$0.00
Application Date: 2/27/2002
Permit Issue Date: 2/27/2002
Amount Paid Payer
Receipt Nbr: 1166 Transaction Date/Time:
2/27/2002 10:55:12 AM
($126.99) Amount Refunded w/ PeopleSoft Voucher #
Acct Account Transaction
Description
Total Due Amount
Paid
00120 RESIDENTIAL PMTS P
$109.47
$109.47
00150 STATE SURCHARGE P
$4.50
$4.50
P0120 RESIDENTIAL PMTS P
$43.64
$43.64
le=P=Aa+.. Paeool Nutm, I Reemi { CNaainidis
-_. _.. ..
$157.61
$157.61
Tender Type
Checkl
Receipt Nbr: 2751
Amount Paid Payer
$528.72 DREAM ROOM DESIGN
Transaction Date/Time: 4/24/2002 4:45:16 PM
Acct Account
Transaction
Description
Total Due
Amount Paid
00120 RESIDENTIAL PMTS
R $0.00
($87.58)
00150 STATE SURCHARGE
R $0.00
($4.50)
P0120 RESIDENTIAL PMTS
R $0.00
($34.91)
$0.00
($126.99)
Tender Type
Amount Paid Payer
Checkl
($126.99) Amount Refunded w/ PeopleSoft Voucher #
00135115
Refunds
r/Q`CriJ Hole1N...na N/tN:„fl8 D2 •�%. -�,• Ste: 6i9DT 1j
6wy ..: J P,gee1 Ns.
Roiect Atm@elence ._ ._
gereip3IF
_._
... � A{94ca03 { gac Addca � lrYutt seeNe { 8c1�. { rte.
{ lliodwe4 I FAe�om { lc>
f—tobe Reed Ref -Cl Ax -1(
le=P=Aa+.. Paeool Nutm, I Reemi { CNaainidis
-_. _.. ..
I _. frvdlug { &ig
9NandAeawrt
,I
fldrnd Tfpe
Raadlltr Irn 1pe Mdst Mb ) Ode 4 t '
F Vwr.Aa f Cie Cad
_
Origird Rdurnl
Ret Amud Fae
Rnlred De1f11ae !I"PT"'-'g'rT=#�'7:
Mvoipe fleFvd Relad .. " � Um 1D
—.P D
I— racrytion Paid AwaN
Aaovd Poreenl Avant
i1f FU l., 'M,', V °.4! I10: h:'
I' 34'x' it -i1
tl 4i 800 38].58 liana - PM ]nwdvdeocov:
S—. 1000 3450 Prgl Coen I kd0 Iran Ar /,Pe
D- 10 Ta
.. !U . 1 4 i! ± 64 t :.1;4
$I? [4 80.0 334.91 'i ..1!8' - f h 1381 581
334911
991
W1
NH 7-A—d JIM 991
tNeq tD Nn
Doc ID: PPS 0 135115
fl.nson Appk— Canceeed pap fence)
Tin 0—/ISNo kSO 00
Nd 1--l- ,S, ”. "tel
-- FIVM
UUNTY
SPP 3 2gp-
D re am'iZoom
Design L.i-c.
April 22, 2002
Spokane County Division of Building & Code Enforcement
1026 West Broadway Avenue
Spokane, Wa. 99260
Re: Project Number 02001188
Dear Sirs,
The above referenced project will not be built and therefore I would like to request a
refund on the permit issued February 27, 2002.
If you need more information please contact me at 922-7388.
Thank you
William K. Conant
gCEMENT
P.O. Box 141708 * Spokane, Washington 99214-1108 * 509-922-7388 * Toll Free: 1-888-282-8009
www.dreamroomdesign.com
Voucher ID 00135115
Vendor ID DREARODE
Invoice # PRJ# 02-1188
Dept ID
VENDOR:
Dream Room Design
PO Box 141708
Spokane WA 99214-1708
Vendor Contact/Tel
SPOKANE COUNTY PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
SHIP TO: BILL TO:
PAGE 1 OF 2
Rel Vchr
RC#
ENTERED DATE: 04/24/2002 PO DATE: BUYER:
ACCTG. PERIOD: 04/2002 ENTERED BY: Patty Eickstadt PURCHASING DIRECTOR: BELA G. KOVACS
LINE NO. I DESCRIPTION I ITEM ID QUANTITY UNIT UNIT PRICE I EXTENDED AMOUNT
PO# CHG ORD# I PO LINE# I PO SCHED# CONTRACT#
I xU '/o- Retnd'd = Pjr # 02-1188 0.0000 0.00 4.50
0 0 0
2 Bace's Resident Portion 0.0000 0.00 87.57
0 0 0
3 Crrnt Ping's Portion of Reside 0.0000 0.00 34.91
0 0 0
LINE NO. I DISTRIB LINE I ACCOUNT I FUND I DEPTID I PROGRAM CLASS I RPT CAT I BDPER I PC UNIT I PAY THIS AMOUNT
PROJECT ACTIVITY I RES. TYPE I CATEGORY SUB CAT I AM UNIT I PROFILE I ASSET FLG I ASSET ID
1 1 LS /UU N2U
N
2 1 221002 406 0300008 2002 PROJA
BACE 240 REFND N
3 1 221002 417 4170000 2002 PROJA
CPLAN 6030 REFND N
4.50
87.57
34.91
Voucher ID
00135115
Vendor ID
DREARODE
Invoice #
PRJ# 02-1188
Dept ID
VENDOR:
Dream Room Design
PO Box 141708
Spokane
✓endor Contact/Tel
WA 99214-1708
SPOKANE COUNTY PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
SHIP TO:
BILL TO:
PAGE 2 OF 2
Rel Vchr
RC#
ENTERED DATE: 04/24/2002 PO DATE: BUYER:
ACCTG. PERIOD: 04/2002 ENTERED BY: Patty Eickstadt PURCHASING DIRECTOR: BELA G. KOVACS
LINE NO. I DISTRIB LINE ACCOUNT I FUND I DEPTID I PROGRAM CLASS RPT CAT I BDPER I PC UNIT I PAY THIS AMOUNT
PROJECT I ACTIVITY I RES. TYPE I CATEGORY SUB CAT I AM UNIT I PROFILE I ASSET FLG I ASSET ID
Comments: 80% - Refunded = Applicant Cancelled - Prj # 02-1188 ; Site Location:
14713 E. Mission Ave.; Spokane WA 99216
RECEIVING CERTIFICATION
PAYMENT CERTIFICATION
DISCOUNT
TOTAL:
0.00
FREIGHT
TOTAL:
0.00
SALES TAX
TOTAL:
0.00
SUBTOTAL:
126.98
USE TAX
TOTAL:
0.00
GRAND
TOTAL:
126.98
TOTAL TO VENDOR: 126.98
TRAVEL CERTIFICATION
Materials noted in quantity ' have been received in goal condition or 1, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted I hereby certify under penalty of perjury that this
contracted for, for this claim, the materials have been furnished, services rendered or labor performed as described is a true and correct claim for necessary expenses
herein or contracted for, that the claim is a just, due and unpaid obligation against Spokane County incurred by me and that no payment has been received
or fund agency indicated abov that 1 am authorized to authenticate and certify to said claim. by me on account thereof,
SIGNED _ �jSIGNED _ SIGNED
DATE _4/24/02 I AC _ ECH_4 DATE 4/24/02 TITLE ASSIS .. DIV OF BLDG & DATE
GOD, �TFORCEMENT
SIGNED s IGNED ✓ sem' e TT
DATE: = f -0 TITLE: ASST TO CEO DAT E• J/ TITLE:
TITLE
,r