2001, 03-29 Permit: 01001018 Refund1
sect Receipt Summary
Address 18014E SPRINGFIELD
GREENACRES WA 99016,
Owners Name: NILLES, RANDY____
Address: 18014 E SPRINGFIELD AVE
GREENACRES WA 99016
Occupant:
Applicant: NILLES, RANDY
March 29, 2001 Page I of 1
)RZROJECT#: 01001018
Phone: (509) 928-4231
Phone:
Phone: (509) 928-4231
Receipt Nbr: 1885 Transaction Date/Time:
Use: ATTACHED GARAGE (26 X 40 X 10)
Acct Account Transaction
Application Date: 2/23/2001
Description
Permit Issue Date: 2/23/2001
Amount Paid
Receipt Nbr: 1037
Transaction Date/Time:
2/23/2001 9:58:21 AM
P0120 RESIDENTIAL PMTS R
Acct
Account
Transaction
.- ?. 4'G. .£r: rfi}'/v:ff.r: rff%"•?'^.�{.?: .... r. .ry
P:fC:{?:?}cif.M:=i.?ri/%:Sv:�'f.�:r%/rp.:rxt.'lx:iA}Y.?r.}}fi%�r:.;'.�Y�•}f iYF.ri:•:?rim:ftl,:.;:?}rnfl.}•:?:?•}%.X?:.r....-0ii::•}:ti:r'rv.'•iY..Y.{.}:•?Yi::•}.?�i�?::.il:�i::ii::::i::i::i:'r::
ri:j?}}:?: Ff:}::::.:.rd.-0n:i:
Description
Total Due
Amount Paid
P0120
RESIDENTIAL PMTS
P
$78.41
$78.41
00150
STATE SURCHARGE
P
$4.50
$4.50
00120
RESIDENTIAL PMTS
P
$196.70
$196.70
$279.61
$279.61
Receipt Nbr: 1885 Transaction Date/Time:
3/29/2001 3:44:47 PM
Acct Account Transaction
Description
Total Due
Amount Paid
00120 RESIDENTIAL PMTS R
$0.00
($17.88)
P0120 RESIDENTIAL PMTS R
$0.00
($6.52)
? / •}:{i?xm::::n lY :i.
.{•. ?r'�%�'{ /�' vet +�% }.. !rrr..f fi,•'?f frr. r� f j �..f{ ff.. f.. 4 ! -.% '
•i}'?y�=�'}%?ti?SY.: �'rrr'% •KYn}};r?•.}•: ......... $ tiiiiJir•
.- ?. 4'G. .£r: rfi}'/v:ff.r: rff%"•?'^.�{.?: .... r. .ry
P:fC:{?:?}cif.M:=i.?ri/%:Sv:�'f.�:r%/rp.:rxt.'lx:iA}Y.?r.}}fi%�r:.;'.�Y�•}f iYF.ri:•:?rim:ftl,:.;:?}rnfl.}•:?:?•}%.X?:.r....-0ii::•}:ti:r'rv.'•iY..Y.{.}:•?Yi::•}.?�i�?::.il:�i::ii::::i::i::i:'r::
ri:j?}}:?: Ff:}::::.:.rd.-0n:i:
Vendor ID NILLRAND
Voucher ID 00081870
Rel Vchr ID
Dept ID
VENDOR:
Nilles, Randy
18014 E Springfield Ave
Greenacres WA 99016
Vendor Contact/Tel
SPOKANE COUNTY PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
SHIP TO:
BILL TO:
PAGE I OF i
RC#
INV# 01-1018
ENTERED DATE: 03/29/2001 PO DATE: BUYER:
ENTERED BY: PEickstadt PURCHASING DIRECTOR: BELA G. KOVACS
att
LINE NO. DESCRIPTION ITEM ID QUANTITY UNIT UNIT PRICE I EXTENDED AMOUNT
PO# CHG ORD# I PO LINE# I PO SCHED# CONTRACT#
1 uu io - Ketna"U Valuation A(1Jstm 1.0000 LOT 0.00 24.40
0 0 0
LINE NO. DISTRIB LINE ACCOUNT I FUND I DEPTID I PROGRAM CLASS I RPT CAT I BDPER I PC UNIT PAY THIS AMOUNT
PROJECT ACTIVITY I RES. TYPE I CATEGORY SUB CAT I AM UNIT I PROFILE ASSET FLG ASSET ID
1 1 1.21002 406 0300008
BACE 240 REFND
Comments: VALUATION ADJUSTED ON PRJ# 01-1018 - SITE LOCATION: 18014 E.
SPRINGFIELD AVE.; GREENACRES WA 99016 80% REFUNDED OF
VALUATION ADJUSTMENT.
RECEIVING CERTIFICATION PAYMENT CERTIFICATION
Materials noted in quantity " have been received in good condition or 1, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted
contracted for. for this claim, the materials have been furnished, 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 1 am authorized to authenticate and certify to said claim.
SIGNED SIGNED
DATE 3/29/01 TITLE ACCT TECH 4 DATE 3/29/01 TITLE OFFICE ADMINISTRATOR
2001 PROJA 24.40
N
DISCOUNT TOTAL:
0.00
FREIGHT TOTAL:
0.00
SALES TAX TOTAL:
0.00
SUBTOTAL:
24.40
USE TAX TOTAL:
0.00
GRAND TOTAL:
24.40
TOTAL TO VENDOR: 24.40
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
DATE TITLE
Yv �uN� O-� C�.Q W�otJ� (.72-i'�e�-�h iv�c�
_� d,4.� �e��zs o� Sr�e �{o
�o..�-a,�Q, .
REQUEST FOR REFUND
Today's date: �5 - ao - Q
Person/company requesting refund: 0, L�e-� Phone: q ;I'-
Project no.: - l Q l 0 Date paid: Receipt #:
Project name/address: l
Refund To:
Name: N 1 � ) Es
Address: 1 (�V 1 `-i e Z- ' i K �,, Ft e(- .tN avQ (-/f7 10IAJArlt C t" -OA 7 Wl-
Reason for the refund (attach a copy of the land use application or permit for documentation) :
Refund Calculation:
Fee Description Valuation (if applicable) Amount Paid Refund Amount
so
moo . sd
so
__
Total:
Office Administrator approved for payment: ��-
Dated: -�
Voucher #: 7
Accounting Tech
Processed on:
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 W Broadway Avenue ♦ Spokane, WA 99260
(509) 477-3675 Phone
pk (509) 477-4703 Fax Revised: 03/24/2000
Vendor ID NILLRAND
Voucher ID 00081870
Rel Vchr ID
Dept ID
VENDOR:
Nilles, Randy
18014 E Springfield Ave
Greenacres WA 99016
Vendor Contact/Tel
SPOKANE COUNTY PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
SHIP TO:
BILL TO:
PAGE 1 OF 1
RC#
INV# 01-1018
ENTERED DATE: 03/29/2001 PO DATE: BUYER:
ENTERED BY: Patty Eickstadt PURCHASING DIRECTOR: BELA G. KOVACS
LINE NO. I DESCRIPTION I ITEM ID QUANTITY I UNIT I I EXTENDED AMOUNT
PO# CHG ORD# I PO LINE# I PO SCREW CONTRACT#
1
?SU'lo - Ketnd"d Valuation Adjstm 1.0000 LOT 0.00 24.40
0 0 0
LINE NO. DISTRIB LINE ACCOUNTI FUND I DEPTID I PROGRAM CLASS I RPT CAT I BDPER I PC UNIT I PAY THIS AMOUNT
PROJECT IACTIVITY RES. TYPE I CATEGORY SUB CAT I AM UNIT I PROFILE I ASSET FLG I ASSET ID
1 1 LLIUUL 4U6 UJ00008
BACE 240 REFND
Comments: VALUATION ADJUSTED ON PRJ# 01-1018 - SITE LOCATION: 18014 E.
SPRINGFIELD AVE.; GREENACRES WA 99016 80% REFUNDED OF
VALUATION ADJUSTMENT.
RECEIVING CERTIFICATION PAYMENT CERTIFICATION
Materials noted in quantity " have been received in good condition or I, the undersign, do hereby certify under penalty of perjury that sufficient funds have been budgeted
contracted for. for this claim, t e materialslillwe
been furnished, services rendered or labor performed as described
herein or contrac eed for, that the ch' t is a just, due and unpaid obligation against Spokane County
or fun agency indlFated abov�, that 1 u authorized to authenticate and certify to said claim.
'41y
SIGNED SIGNED
DATE
3/29/01 TITLE ACCT TECH 4 DATE 3/29/01 TITLE \ OFFICE ADMINISTRATOR
_
2001 PROJA 24.40
N
DISCOUNT TOTAL:
0.00
FREIGHT TOTAL:
0.00
SALES TAX TOTAL:
0.00
SUBTOTAL:
24.40
USE TAX TOTAL:
0.00
GRAND TOTAL:
24.40
TOTAL TO VENDOR: 24.40
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
DATE TITLE