1996, 12-03 Permit: 96009008 RefundLGFS PAYMENT DOCUMENT
r v
t-,. A. r.
REFUND
SPOKANE COUNTY AUDITOR
Change Order #
Iv# M V 120260441
)ept EWORCE
Bid ID
SHIP TO: BILL TO:
Blanket#
VENDOR:
BARTONS HEATING C AIR
_
RC#
�
11401 E MONTGOMERY AVE
WA
99206
�#
SPOKANE
Confirming Order
Vendor Contact/Tel
BLDG/ROOM:
BUYER
FOB:
ACCTG. PERIOD: 12/96
PO DATE:
DN ELIVERY DATE: WAREHOUSE:
P A T R IC 1A c I C K 5 T A D T
UR HA ING DIRE TOR: D O N A L D
L. L A R S C U f=
MMENT
IERED BY:
UNIT
REF ACCT L OUA UNIT
P E TAL PRI E
CO
80%9 CANCELLEDiPRJr96-9008
30•40
SITE: 7310 E.
SINTO AVE.
SPOKANE
WA 99212
PAGE TOTAL:
30.40
0.00
DISCOUNT TOTAL:
0.00
FREIGHT TOTAL:
0.00
SALES TAX TOTAL:
30.40
PURCHASE ORDER VALUE:
0*00
USE TAX TOTAL:
30.40
GRAND TOTAL:
B CA
B C T N PAY THIS AMOUNT P/F
B B B
30.40
�
2210 07
O1 406 030
0008
TOTAL TO VENDOR:
30 * 40
_
TRAVEL CERTIFICATION
FICATION
have been
P N CERTIFICATION
the unders do hereby certify under pe alty of perjury that sufficient funds have been budgeted for this claim, the
contracted for, that the cl is
I herebycertifyunder penalty of perjury that this
is a true and correct claim for necessary expenses
Materials in qu tity /
cd i d co ition contra ed for.
terials have wished, services ren ed or labor performed as described herein or
County or fund agency indicated above, that I am authorized to authenticate
y me and that o payment has been received
incurred bme
rece
a j due and unp obligation agai pokane
onac ount thereof.
SIGNS _
c ity to
ADMOR INISTRAT
SIGNED TITLE
1
TITLEACCT TECH III
TITLEOFFICE
SIGNED
PAGE
DATE
/ n 3 /
DATE] 21 X1-96
DATE
ACCOUNTS PAYABLE
SPOKANE COUNTY DIVISION OF BUILDING .AND PLANNING
1026 W. BROADWAY� >*, SPOKANE, WA 99260-0050
(5o9) 456-3675
SITE INFORMATION PROJECT INFORMATION
SITE ADDRESS: 7310 E SINTO AVE
SPOKANE WA 99212
PARCEL NUMBER: 35131.0515
SUBDIVISION: PARK ROAD ADD
LOT: 15 BLOCK: 5 ZONE: UR -3.5
INSPECTOR: FRANK PALADICHUK
WATER DIST:
OWNER: RIESAN, LOLA / AL HARRIS
PHONE: 509 991 3314
ADDRESS: 7310 E SINTO AVE
SPOKANE WA 99212
PROJECT NUMBER: 96009008 ISSUE DATE: 10/15/96
PERMIT USE: GAS FURNACE & PIPING
APPLICANT: BARTONS HEATING & A/
PHONE: 509 922 5000
ADDRESS: 11401 E MONTGOMERY AVE
SPOKANE WA 99206
CONTACT: DAVE - BARTONS PHONE: 509 922 5000
SETBACKS -> FRONT: NA LEFT: NA RIGHT: NA REAR: NA
LENDER NAME:
PHONE:
ADDRESS:
PERMIT(S)
MECHANICAL PERMIT
CONTRACTOR
BARTON HEATING & A/C INC
LICENSE #: BARTOHA110BZ
GAS APPLIANCE -100,000B 1
GAS PIPING 1
PROCESSING FEE 25.00
TOTAL PERMIT FEE $38.00
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MI/0
PAYMENT SiTMMARY
NOTES
PAYMENT DATE RECEIPT# PAYMENTAMOUNT
�(�b
cQ�
10/15/96 00010941 $38.00
yI
C I
������
TOTAL FEES AMOUNT PAID AMOUNT OWING
----------
- - ---$38.00 ------$38.00
$.00
ISSUED PERMIT BY: JULIE SHATTO
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