1994, 08-31 Permit: 94007907 RefundPV#
Dept -C
LGFS PAMENT DOCUMENT
SPOKANE COUNTY AUDITOR
VENDOR Sim M.
TLC .iNST?UCTION
13,816 E. 12TH AVENW:
SP10KANE-t WA 99216
Vendor Cordact/Sel
Cordnrrung Order
Bnl M.
Charve Order #.
Bid ID
Blanket#
RC#
VI#
FOB: PO DATE: BLDG/ROOM: BUYER
ACCTG. PERIOD: DELIVERY DATE: WAREHOUSE: 1, t
COMMENTS- ENTERED RY- PURCHASINQ DIRE TOR -
COMM LN# DESCRIPTION
COMMODITY NO REF ACCT LINE QUANTITY UNIT UNIT PRICE TOTAL PRICE
— bi4 J. PiL, RCE 6), o J1 Vs�' 10iLE , Jitl iNGti L.WiCELED-60% ' tD i NL)
]i) i. r v ;"4v 0 .. 11
$49.00
-35.00
14.00 X 80% = $11.20
SYSTEM VOID.�� `"ccQJ
PAGE TOTAL: 11•.
t,RAl, Z TOTAL: 11.2:.
INE NO. I FUND AGCY j ORG I SB ORG ACT OBI SB OBI REV SRC I SB REV I RPT CAT BS ACCT JOB NO PAY THIS AMOUNT P/F
RECEIVING CERTIFICATION
Materials noted in quantity ./ have been
received in good condition or contracted for
SIGNED
TITLE
DATE v
PAYMENT CERTIFICATION
TRAVEL CERTIFICATION
I, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted for this claim, the
I hereby certify under penalty of perjury that this
materials have been furnished, services rendered or labor performed as described herein or contracted for, that the daim is
is a true and correct claim for necessary expenses
a just, due and unpaid obligation against Spokane County or fund agency indicated above, that 1 am authorized to authenticate
incurred by me and that no payment has been received
and certify to said claim.
by me on account thereof.
SIGNED TITLE SIGNED TITLE
PAGE
sapoo a!geo!ldde 41!AA sapdwoo l!wjad s!y1 to luoil a41 uo paquosap asn O41 1e41 1! of eas of 'Alunoo aumiodS lou 'aall!waad a4l to Alg!q!suoasa, dt
!SPO_
a
:�A►NE COUNTYLIEPARTMENT OF. B
WEST 1026 BROADWAY $P0 UILDINGS
KANE, WA 99260-0050
(509) 456-3675
.....•atm a iv1V
SITE ADDRESS: 614 S PIERCE RD
SPOKANE WA 99206
PARCEL NUMBER: 45212.1341
SUBDIVISION: OLD ORCHARD SUB
LOT: 32 BLOCK: 2 ZONE: AGSUB
INSPECTOR: REED OCKEY
WATER DIST:
OWNER: LUNBARZ, MARK
PHONE: 509 9216904
ADDRESS: 614 S PIERCE RD
SPOKANE WA 99206
CONTRACTOR
BESTWAY PLUMBING
LICENSE #: BESTWP*088MT
\ TOILETS/BIDETS 1
SHOWERS 1
SI 1
ATER PIPING
PROCESSING FEE 25.00
TOTAL PERMIT FEE $49.00
PAYMENT DATE
------------
08/15/94
-- - TOTALFEES-
$49.00
ISSUED PERMIT
PROJECT NUMBER: 94007907
ISSUE DATE: 08/15/94
PERMIT USE: TOILET, SHOWER, SINK, REVERSAL
APPLICANT: TLC CONSTRUCTION
PHONE: 509 926 6760
ADDRESS: 13816 E 12TH AVE
SPOKANE WA 99216
CONTACT: GENEVA PHONE: 509 926 6760
SETBACKS -> FRONT: NA LEFT: NA RIGHT: NA REAR: NA
LENDER NAME:
PHONE:
ADDRESS:
RECEIPT# PAYMENT AMOUNT
--------------
00009475 549.00
-AMOUNT-PAID AMOUNT OWING
---------
$49.00 $.00
BY: CAROL FRAZIER
17
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