The URL can be used to link to this page

1995, 07-14 Permit: 95004416 RefundLGFS PAYNMNT DOCUMENT PV# SPOKANE COUNPY AUDITOR Dept V9NDOR SHP TO: Bn1 TO: DAVID P*O*B. 30182 SPOKANF i WA 99223 Vendor Conlact/Tel Cortfurrtmg Order Change Otter # Bid ID Blanket# RC-#_ VI# FOB:PO DATE: BLDG/ROOM: BUYER ACCTG. PERIOD: 07/95 DELIVERY DATE: WAREHOUSE: COMMENTS- ENTERED BY- PURCHASIN(-, n1RFQTQR COMM LN# DESCRIPTION COMMODITY NO REF ACCT LINE UANTITY UNIT UNIT PRICE TOTAL PRICE r95004416-80% REFUND $820.69 X 80% _ $656.66 056.55 100% REFUND $4.50 X 100% = 4.50 4.;Q PROJECT CANCELED -80% REFUND $84.00 X 80% = 67.20 67.2Q SUNNYVALEDR40% Rr-D $108.00 X 80% = 86 40 . 86940 TOTAL REt=UND 86.46 $814.65 406 PAGE TOTAL: 814.65 DISCOUNT TOTAL: 0.00 FRE0000, SYSTEM VOID LES TAXGHT TOTAL: 0 *00 SALES TAX TOTAL: G.:}0 PURCHASE ORDER VALUE: 814.6ry5 USE TAX TOTAL' 0000 TT:ji I LINE I FUND I AGCY I ORG I SB ORG I ACT I OBI i SB OBJ I REV SRC I SB REV I RPT CAT IBS ACCT I JOB NO I PAY THIS AMOUNT I Pit' tNO. . J .r 02 406 030 000e2210 03 86.46 03 406 030 0008 2210 C7 67.20 04 N20 675 37d,. 4.50 RECEIVING CERTIFICATION Materials noted in quantity / have been received in good condition or contracted for. SIGNED TITLE !fGeT TECH DATE7,114/96 PAYMENT CERTIFICATION 1, the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted 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 I am authorized to authenticate and certify to said claim. SIGNED,/ TITLE n t DATE DEPARTMENT2 TOTAL TO 14.65 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 PAGE I SPOKANE COUNTY DEPARTMENT �OFBUILDINGS 4 WEsr 1026 BROADWAY e SPOKANE, NNIA 99260-0050 (509) 456-3675° _SITE Ir1FORMnrIOly � � _ PROJECT IDWOltMATIorr SITE ADDRESS: 4905 N SUNNYVALE DR SPOKANE WA 99216 PARCEL NUMBER: 46364.0405 SUBDIVISION: CHINOOK NO. 1 (CHINOOK ESTATE LOT: 5 BLOCK: 4 ZONE R- .5 INSPECTOR: STEVE HOLYK WATER DIST: CONSOLIDATED IRRG OWNER: DAVID RYAN PHONE: 509 994 4527 ADDRESS: POB 30182 / SPOKANE WA 992 3 CONTRACTOR OWNER LICENSE #: NEW BUILDING DIM.= 40 X 60 2 STORIES SO FT = 2614 BASEMENT U R-3 VN 906 GARAGE M-1 VN 720 RESIDENCE R-3 VN 906 2ND FLOOR R-3 VN 802 TOTAL VALUE: $115,264.00 RESIDENTIAL VALUATION 695.50 STATE SURCHARGE 4.50 RESIDENTIAL SURCHARGE 125.19 TOTAL PERMIT FEE 5825.19 K T U SP N LICEN E #: USP *153MA GAS APP IANCE = 00,0008 1( CLOTHES RYE GAS WATER ATER 1 GAS PIPING 2 VENTILATING FANS 4 HOOD -TYPE II A 1 TOTAL PERMIT FEE $84.7 C� i PROJECT NUMBER: 95004416 ISSUE DATE: 06/27/95 PERMIT USE: RESIDENCE - NATURAL GAS PLICANT: RYAN, DAVID PHONE: 509 994 4527 ADDRESS: POB 30182 SPOKANE WA 99223 CONTACT: DAVID RYAN SETBACKS -> FRONT: 35 LENDER NAME: PHONE: ADDRESS: (S) `P NBING`PERMIT" CONTRACTOR GOL SEA MECHANICAL INC LI ENSE #: GOLDSM*290C4 KE S/BIDETS S NKS DISH W SHERS 'CLOTHES WASH R FLOOR DRAI WATER USIN TOT PERMIT PHONE: 509 325 9162 LEFT: 10 RIGHT: 10 REAR: 50 PAYMENT SUMMARY NoTrs PAYMENT DATE RECEIPT# PAYMENT AMOUNT 06/27/95 00005670 $2,047.19 TOTAL FEES AMOUNT PAID AMOUNT OWING ------------- ------------ ------------- $2,047.19 $2,047.19 $.00 ISSUED PERMIT BY: JOHN LARSON -MI-SC-FEES-DUE-- CONTRACTOR MISC-FEES-DUE--CONTRACTOR OWNER LICENSE #: 3 APPROACH INSPECTION 2 APPROACH PERMIT 6 PERFORMANCE BOND: 208 1 1 TOTAL PERMIT FEE $1,030.0 0 ACTION: R SCREEN: RFDS USERID: MSTI ' H— -------------------------------------------------------------------------- BUILDING PERMIT SYSTEM REFUND ENTRY TABLE USE "G" ACTION AND "X" LINE OR LINES TO BE ADDED OR DELETED SUB—ACTION: -------------------------------------------------------------------------- JUR= 11 PROJECT NUMBER= 95004416 ACCT ACCOUNT AMOUNT REFUND REFUND VOUCHER TYPE CODE DESCRIPTION PAID DATE AMOUNT NUMBER -- ----- ----------------------------- ----------------- 0610 ----------- Le 5� 16� 01— BU 00120 RESIDENTIAL PMTS 820.69 02— BU 00150 STATE SURCHARGE 4.50 03— ME 00410 MECHANICAL PMTS 84.00 , 04— MS E0002 ENGR—PERMITS 10.00 05— MS E0003 ENGR—INSPECTIONS 20.00 06— MS E0004 ENGR—PERFOR.BOND 1,000.00 -- 07— PL 00610 PLUMBING PMTS 108.00 08 — .,..� ... 0 9 — M 10— 1, 08—*L009 HEADER CHANGE