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1995, 05-30 Permit: 94005390 Refund
Pv# Dent JRCE VENDOR: G_ i ; C0t4ST:RUCT10N 12bt9 E SPRAGUE AVE SPOKANE, ,4A 99216 Vendor Contact/Tel .. 2 LGFS PAYMENT DOCUMENT SPOKANE COUNTY AUDITOR SHIP TO: Cordoning Order BILL TO: Change Order # MID Blanlaet# RC# VI# FOB: ACCTG. PERIOD: COMMFNTS• PO DATE: DELIVERY DATE: F.NTFRED BY. BLDG/ROOM: WAREHOUSE: COMM LN# DESCRIPTION BUYER PURCHASING DIRECTOR. COMMODITY NO REF ACCT LINE QUANTITY UNIT UNIT PRICE TOTAL PRICE ::940©5390 $108.00 X 80f = TOTAL REFUND Cid ffk 3 86.40 $691.70 u.:; 3000 RAGE TOTAL: DISCOUNT TOTAL: E:' IGHT TOTAL: SALES TAX TOTAL: PURCHASE ODER VALUE: USE TAX TOTAL: 36.40 0.00 0.00 0.03 691.70 0.00 LING NO. FUND l AGCY. I ORG _SB ORG 1 ACT OBI SB OBI _ REV SRC _ SB REV 1 RPT CAT BS ACCT JOB NO. LJA 02 03 04 05 06 406 406 406 406 N20 030 030 030 000 675 0008 0008 0008 2210 03 2210 07 4150 02 0173 3170 3700 TC .. PAY TI•iIS AMOUNT '2,..22 86.40 60.00 12. 57 1.01 4.50, 691.70 P/F RECEIVING CERTIFICATION PAYMENT CERTIFICATION Materials noted in quantity J 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 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 SIGNED " and certify to said claim. TITLE SIGNED TITLE DATE DATE DEPARTMENT 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 TITLE DATE PAGE Pv# Dept :JnacE VENDOR GRA:ONSTRUCTION 12609 E SPRAGUE AVE 42 SPOKANE, WA 99216 Vendor Contact/Tel LGFS PAYMENT DOCUMENT SPOKANE COUNTY AUDITOR SHIP TO: Confirming Order BILL TO: Change Order # Bid ID Blanket# RC# VI# FOB: ACCTG. PERIOD: COMMENTS_ 7/97 PO DATE: DELIVERY DATE: ENTERED BY: BLDG/ ROOM: WAREHOUSE: BUYER PURCHASING DIRECTOR• COMM LN# DESCRIPTION COMMODITY NO r REF ACCT LINE QUANTITY UNIT UNIT PRICE TOTAL PRICE *9400'5390 3909 S UNION CT NEW PERMIT #95-1807 ISSUED - 80% REFUND $4.50 X 100% 0.94005390 $1.01 X 100% _ c9400530 $12.57 X 100% _ C9400::;::390 $659.03 X 80% = $ 4.50 1.01 12.57 60.00 527.22 V. V'v0vViIivu 0.000000 0.000000 0.000000 0.000000 PAGE TOTAL: 't. ->i 1.01 12.57 60.00 527.12 605.30 LINE NO. FUND I AGCY ORG SB ORG I ACT OBI SB OBI 1 REV SRC SB REV i RPT CAT I BS ACCT JOB NO. PAY THIS AMOUNT P/F RECEIVING CERTIFICATION Materials noted in quantity ✓ have been received in good condition or contracted for. SIGNED TITLE DATE PAYMENT CERTIFICATION I, 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 1 am authorized to authenticate and certify to said claim. SIGNED TITLE DATE DEPARTMENT 2 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 ,Pct _7-� _#9,I‘c> j—',7 70 tea_ .e..e311., /76r? � - ACTION: R SCREEN: RFDS USERID: M5TI 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= 94005390 ACCT ACCOUNT AMOUNT REFUND REFUND VOUCHER TYPE CODE DESCRIPTION PAID DATE AMOUNT NUMBER 01- BU 00120 RESIDENTIAL PMTS 659.03 597.aa ge 70 02- BU 00150 STATE SURCHARGE 4.50 9 ,f $ -- (cry 70 03- BU 00181 MISC. MONITOR 12.57 Ia,sr ( ee G70 04- BU 00182 SALES TAX 1.01 1. 02 j ov `7e 05- ME 00410 MECHANICAL PMTS 75.00 06- MS E0002 ENGR-PERMITS 10.00, 0 00 ^ KJ /6 07- MS E0003 ENGR-INSPECTIONS 20.00 /; 08- PL 00610 PLUMBING PMTS 108.00 -' q - 50 To09- l�' 10- 06,i1 09 -*L009 HEADER CHANGE b i' 1 , 70 5V ---1).1)