1999, 10-05 Permit: 99001959 Refund40,070hdor ID STROTIMO
Voucher ID 00013109
Rel Vchr ID
Dept ID Building and Planning
VENDOR:
Stromberger, Tim
18625 E Riverway Rd
GI-CenacfCs WA 99016
VrnJnr f'nnlarl/•I1•I
SPOKANE COUNTY PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
SHIP TO:
BILL TO:
PAGE I OF 1
RC#
INV# 99-1959
I:N'IIERED DA'L'E : 10/14/1999 PO DATE: BUYER:
ENTERED BY: Patty Eickstadt PURCHASING DIRECTOR: BELA G. KOVACS
LINE NO. I DESCRIPTION INV ITEM ID QUANTITY UNIT UNIT PRICE EXTENDED AMOUNT
PO# '�� ` ,"� CHG ORD# PO LINE# PO SCHED# CONTRACT#
I Inn% RFND'D PI.N AFVIEW 1.0000 EA 170.95 170.95
0 0
LINE NO. I DISTRIB LINE ACCOUNT I FUND I ORG I PROGRAM SUB -CLS I RPT CAT I B. YR I PC UNIT 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 458301 406 0300008 1999 PROJA 1/U.9-)
DOBP 260 REFND N
Comments: 100% REFUNED OF THE PLAN REVIEW PORTION OF PERMIT # 99-1959; DISCOUNT TOTAL: .00
SITE LOCATION: 18625 E RIVERWAY RD. FREIGHT TOTAL: .00
SALES TAX TOTAL: .00
GREENACRES WA 99016 SUBTOTAL: 170.95
USE TAX TOTAL: .00
GRAND TOTAL: 170.95
TOTAL TO VENDOR: 170.95
RECEIVING CERTIFICATION
Materials noted in quantity • have been received in good condition or
contracted lor.
SIGNED
DATE __Jn//q9 TITLEACCT TECH
PAYMENT CERTIFICATION
I, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted
for this claim, lh aterials have furnished, services rendered or labor performed as described
herein or contracted for, that the claini•g 'ust, due and unpaid obligation against Spokane County
or fund agency indicated ahove, that [ am orizelllto authenticate and certify to said claim.
I N i
SIGNED _ _, C '
DATE 1 n/�g TITLE 0 ->a -FLT -CE ADMINISTRATOR
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
DATE TITLE
Project Number: 99001959 Inv: I Application
Date: 9/22/99 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
--- Building Permit
Contractor: UNKNOWN
Firm: UNKNOWN
Address: UNKNOWN
Phone: (000) 000-0000
UNKNOWN, WA UNKNOWN
Building Characteristics
Const Category: Addition
Nbr Of Dwellings: Occupant Load:
Bldg W x D: 20 x 40 Building Sq Ft:
Req Parking: Handicap Parking:
Description Grp Type Notes
REPAIR GAR S-3 VN
Item Description
COMMERCIAL VALUATION
PLAN REVIEW FEE
COMMERCIAL SURCHARGE
STATE SURCHARGE
Payment Sttntnrary:
Operator: JAS
Permit Type
Building Permit
Notes:
Totals:
Building Height: El
800 Sprinklers:
Critical Materials: El
This Application:
S%Ft Valuation
800 $17,808.00
800 $17,808.00
Units Unit Desc
1 Y OR BLANK
1 Y OR BLANK
1 Y OR BLANK
I Y OR BLANK
Permit Total Fees:
Stories: 1
Total Project:
Sg Ft Valuation
800 $17,808.00
800 $17,808.00
Fee_ Amount_
$263.00
$170.95
$95.47
$4.50
$533.92
Printed By: PAE rint Date:
Fee Amount Invoice Amo nt Amount Pald
$533.92 $533. $170.95
- $533.92 $533.92 $170.95
9/22/99
$362.97
$362.97
Edit tnsert Records Wmdow HEIP
Refunds
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Type of Refund
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Receipt Nbr Selo Tran Type c'
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Refund
Amount Fee
Prml Account Paid Amount
Amount Pace--
0-0
Amount
SUM a
Type DncrrPtion 50.(10 $utit)
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5170.0rS
$(m)
$170.911 100-0
$170.95 1
OU OLM; CODE: Rfi. 5170.9`1
e: Refund
User to iEr;ksta Tran Type:
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Accept
2 Total Relunded: SI10.95
Dale.
_. Doc ID Tender ..
Amt Type
-
3 Da: ID: PPS1113109 Expiration
Tran
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Project Number 99001959
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Amt Type
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Prof l Comm Inv Acct Desc
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5770 951 K f'hcck1 PPS913109 (ST 70.95)
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99007 9ri9 Z ULDC;. COO..
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Net Tendered
Total Proiects'
($1.70.95) Change SO 00�\i
Net Tenderod
Total Misc:
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$0.00
Net Transaction:
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