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2003, 07-22 Permit: 03003474 AC
Project Receipt Summary Tuesday, July 22, 2003 Pagel oft Address 15918 E RADCO DR PROJECT#: 03003474 Owners Name: PETERSON, DAN Phone: (509) 922-6072 Address: 15918 E RADCO DR. VERADALE, WA 99037 Occupant: Phone: Applicant: R & R HEATING & NC Phone: (509) 484-1405 Use: AIR CONDITIONER *** cancelled 7/21/03 pap *** Application Date: 5/19/2003 Receipt Nbr: 3161 Transaction Date/Time: Acct Account Description 00410 MECHANICAL PMTS Transaction P Permit Issue Date: 5/20/2003 5/20/2003 11:18:12 AM Tender Type VISA Receipt Nbr: 4570 Acct Account Description 00410 MECHANICAL PMTS Amount Paid Payer $123.00 Total Due $37.00 $37.00 Transaction Date/Time: 7/21/2003 3:41:45 PM Transaction D Tender Type VISA Amount Paid Payer ($37.00) Amount credited back to credit card account w/ batch # 10157 ; item # 008 pap Total Due $0.00 $0.00 Amount Paid $37.00 $37.00 Amount Paid ($37.00) ($37.00) c, REQUEST FOR REFUND Date: --t S----Cr- Today's Person/Company requesting refund: E \le - y n Project No: — 3(-7( !Date Paid: 5/00/63 (PLUS Receipt # 1 h ( Project name/address: E' 1 SC1 t2. 'R Pkb O REFUND TO: Name: E H e0 - i�� Phone: L t q �-/yaS pV Address: 4 11 E Ct"7U t City /}� � '(Je .AJ State (it►"n Zip R'4 7 REFUND REASON: `fl n 1 --1--Ld 04' 11,0iLcine.__ OCtlfeti Employee Requesting Refund: - 1VV ��l_.t 6( l FOR OFFICE USE ONLY VALUATION REFUND CALCULATIONS Use Description Square Feet Calculated Value Revised Sq Ft Revised Value REFUND VALUE Total Revised Value = VALUATION REFUND CALCULATIONS Fee Item Fees Paid Revised Fees Difference Percentage of Refund REFUND AMOUNT $ $ $ $ $ $ $ $ $ $ Total Revised Fee = $ $ Other Refund Description: Amount Paid Percentage of Refund REFUND AMOUNT Bldg Portion of Permit $ 80% Bldg Portion of Permit $ Crmt Ping's Portion of Permit $ 80% Crmt Ping's Portion of Permit $ Mechanical Portion of Permit $ "7,(--)() / DO%°r Mechanical Portion of Permit $ 37. DC7 Plumbing Portion of Permit $ 80% Plumbing Portion of Permit $ State Surcharge $ 100% State Surcharge $ Total Am9.ugt4pf Paid $ Total Amount of Refund $ '37, DQ Office Administrator Approval —_ Date: Paid with Voucher / Batch Number. Process Person: PATI YPOOLE Date Processed: SPOKANE COUNTY DIV. OF BLDG & CODE ENFORCEMENT 1026 W. BROADWAY AVE. PWK -1 = SPOKANE WA 99260 (509) 477-3675 Phone (509)477-4703 Fax Filed Under. Prmt Techs Refund.xls