1988, 04-06 Permit: 88000752 Woodstove SPOKANE COUNTY DEPARTMENT OF BUILDING AND SAFETY
NORTH 811 JEFFERSON
SPOKANE, WASHINGTON 99260
(509) 456-3675
I certify that I have examined this permit and state that the information contained in it and submitted by me or my agent to compile said permit is true and correct.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 and 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 regulating construction,or as a
warranty of conformance with the provisions of any state or local laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
PROJECT
-( l: l - ' U"B. 1. 89000752 DATE=
04/06/8O .,...•...
PERMIT
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ADDRESS= SPOKANE WA 99216
PERMIT USE= WOODSTOVE
PLAT.,,..._ 002961 PLAT NAME= W1.:.:.: 1 FARMS I ..: . . ....: . fr
BLOCK= LOT= ZONE=
AREA= 00000000 F/A= F WIDTH=
OWNER= STEFANIK , STEVE 922
STREET= 41:)20 N! I<:I..:L..LI.:I•. RD
ADDRESS= SPOKANE WA 99216
•
CONTACT NAME= OWNER ,
BUILDING SETBACKS FRCNT= NA LEt : NA
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CONTRACTOR= OWNER PHONE=
ITEM DESCRIPTION FEE AMOUNT
PROCESSING FEE 15 , 00
WOODSTOVE/INSERi 10, 00
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PAYMENT D h•i) I::. I'ti I::.i.:L....I'• . .,+. PAYMENTAMOUNT
.
TOTAL DUE= 0 0 TOTAL PAID= 25 , 00
PERMIT TYPE FEE AMOUNT AMOUNT
MO iN r AMOUNT OWING
MECHANICAL i ':NII 25 .00 2":; . 00 .. .. ..
25 , 00 25 , 00
PROCESSED BY : WENDEL , OLCIA
PRINTED DY : WENDEL , C;;LORIA
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SPOKANE COUNTY, PAYMENT VOUCHER
VENDOR
CODE
JAMES S. BLACK AND COMPANY
NAME
ADDRESS S. 107 Howard, #500
SPOKANE, WASHINGTON 99204
•� I �ntilri • I :
sl 4Ir, puN �,� •IC '0' •i
'4';'1110 ; t; l )l: Its. JL I 1116
AUDITORS STAMP
ORIGINATING ENTITY (ALL VOUCHER TYPES)
•
•
1099 REQ'D ID#
LNINE O
INVOICE NUMBER
ACCOUNT
FUND
DISTRIBUTION,
AGENCY
IZAOBJ
ON
ACT
OBJ
SOURCE
REV
NUMBER
CATEG
ACCT
DESCRIPTION
AMOUNT P f :•t;
88-752
010
030
0008
2210
07
refund
S20 00
•
DETAIL
DESCRIPTION
Refs<nding 80% of permit #887,752 issued for a wood
I, the undersigned do hereby
certify under penalty of perjury
TOTAL
$20.00
stove at 4820 North Keller Road.
The occupants of the building removed the stove.
80% of 25.00 = 20.00
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
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
indicated above, that I am autho-
TITLE
VOUCHER •
rized to authenticate and certify
to said claim.
DATE
INTRA -GOVERNMENTAL
FUND
AGENCY
RATION
SUB
ORfil
SELLERS
ACTIVITY
ACCOUNT
REVENUE
SOURCE
REV
SRO
DISTRIBUTION
JOB NUMBER
RPT'
CATEG.
OFFSET)
RECEIVABLES
ACCOUNT
EXAMINED and ALLOWED
DATE 19
CE T161CATION
SIGNED � \•CHAIRMAN
SELLER CERTIFICATION
I, hereby certify that the materials have been furnished, the services SIGNED
TITLE OFFICE MANAGER
MEMBER
rendered or the labor performed as described herein or contracted TITLE
due and that
for, and that the claim is a just, and unpaid obligation,
to DATE
DATE 5/6/88
MEMBER
I am authorized to authenticate and certify said claim.