1994, 04-19 Permit: 94002931 Refund_ LGFS PAYMENT DOCUMENT
Pv# SPOKANE COUNTY AUDITOR
Dept
VENDOR S3W TO: G-� 3 BRI TO:
Vendor CordacdSel Co fl I g Order
Ct,arQe Order #
Bid ID
Blanket#
RC#
VI#
FOB: PO DATE: BLDG%ROOM: BUYER
ACCTG. PERIOD: DELIVERY DATE: WAREHOUSE:
COMMENT,q: ENTERED EY- PURCHASING DIRFCT(-)R-
COMM LN# I DESCRIPTION
COMMODITY NO REF ACCT LINE QUANTITY UNIT UNIT PRICE TOTAL PRICE
- 3725 S RIDGEVIEW DRIVE - PROJECT CANCELED - 80% REFUND
$38.00 X 80% = $30.40
LINE NO. FUND ( AGCY I ORG I SB ORO ACT OBI SB OBI REV SRC I SB REV I RPT CAT BS ACCT JOB NO, PAY THIS AMOUNTP F
RECEIVING CERTIFICATION
PAYMENT CERTIFICATION
Materials noted in quantity ./ have been
1, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted for this claim, the
received in good condition or contracted for.
materials have been fumished, services 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 indicated above, that I am authorized to authenticate
SIGNED
and certify to said claim.
DATE DATE
DEPARTMENT2
TRAVEL CERTIFICATION
1 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
PAGE
Ck-
SPOKANE COUNTY DEPARTMENT OF BUILbINGS
WEST 1026 BROADWAY • SPOKANE, WA 99260-0050
(509) 456-3675
SITE INFORMATION
SITE ADDRESS: 3725 S RIDGEVIEW DR
SPOKANE WA 99206
PARCEL NUMBER: 45321.1009
SUBDIVISION: PONDEROSA 2ND ADD
LOT: 16 BLOCK: 3 ZONE: SFR
INSPECTOR: DAVE SILVA
WATER DIST:
OWNER: EWING, GAIL
PHONE:
ADDRESS: 3725 S RIDGEVIEW DR
SPOKANE WA 99206
YKUJ r;C: l 1Plt' V icivlt� 11vLv
PROJECT NUMBER: 94002931 ISSUE DATE: 04/08/94
PERMIT USE: FURNACE, PIPING
APPLICANT: R & R HEATING
PHONE: 509 484 1405
ADDRESS: 0019 E CENTRAL
SPOKANE WA 99207
CONTACT: R & R HEATING
SETBACKS -> FRONT: NA LEFT: NA
LENDER NAME:
PHONE:
ADDRESS:
PERMIT(S)
PHONE: 509 484 1405
RIGHT: NA REAR: NA
MECHANICAL PERMIT
CONTRACTOR
R & R HEATING & AIR COND INC
LICENSE #: RRHEAA*106BW
AS APPLIANCE -100,000B 1
1
AS PIPING
ROCESSING FEE 25.00
OTAL PERMIT FEE $38.00
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PAYMENT SUMMARY NOTES
PAYMENT DATE RECEIPT# PAYMENT AMOUNT
------------ -------- --------------
04/08/94 00003628 $38.00
TOTAL FEES AMOUNT PAID AMOUNT OWING
$38.00 $38.00 $.00
ISSUED PERMIT BY: DAWN DOMPIER