1997, 12-11 Permit: 97010423 RefundPv#
Dept
REFUND
MV121070009
03� — DuILD
VENDOR:
FALCO STOVE SHOP
9310 E SPRAGUE AVE
SPOKANE
Vendor Contact/Tel
E, PLAN
WA 99206
SHIP TO:
LGFS PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
Confirming Order
BILL TO:
PV MV12107000c.
Change Order #
Bid ID
Blanket#
RC#
VI#
FOB:
ACCTG. PERIOD: 12/ 9 7
COMMENTS:
COMM LN#
PO DATE:
DELIVERY DATE:
ENTERED BY:
BLDG/ROOM:
WAREHOUSE:
PATRICIA FICKSTADT
BUYER
PURCHASING DIRECTOR: Tt tI N A 1 D 1. 1 A B R F C Q U
DESCRIPTION
DIST: "F"
COMMODITY NO
REF ACCT LINE
QUANTITY
UNIT
UNIT PRICE
TOTAL PRICE
CANCELLED,PR.J::97-10423
SITE: 718 N. UNIVERSITY RD.
SPOKANE WA 99206
PAGE TOTAL:
DISCOUNT TOTAL:
FREIGHT TOTAL:
SALES TAX TOTAL:
PURCHASE ORDER VALUE:
USE TAX TOTAL:
GRAND TOTAL:
28.80
28.80
0.00
0.00
0.00
28.80
0.00
28.80
1
AGCY ORG SB ORG
030 0008
RECEIVING,6 TIFICATION
M terials not.in .uan ity / have been
rec.'ved in •o . condi.. or contracted or
/
SIGNED AO.
ACT
2', 20
OBI
SB OBI
REV SRC
2210
SB REV
07
RPT CAT
BS ACCT
JOB NO,
TOTAL TO VENDOR:
PAY THIS AMOUNT P/F
28.80
28.80
TITLE ACCT TECH 3
DATE 12/11/97
PAYMENT CERTIFIC-ATION
I, th ersigned o hereby cekIfy under penalty of perjury that sufficient funds have been budgeted for this claim, the
materials hay een rnished, servifes rendered or labor performed as described herein or contracted for, that the claim is
a just, due and un
and certify to said cl
DATE 12/11/97
Igation against Spokane County or fund agency indicated above, that I am authorized to authenticate
TITLE OFFICE ADMINSITRATOR
A rs/`P51 Ir,ITC rlAVAOI C
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
1
PAGE
',�I 'COMMt.T S 0 O
1°16 siv. BROADY/AY • SPC : A'..9936O-4.0
(509) 456-3675
C
SITE INFORMATION
PROJECT INFORMATION
SITE ADDRESS: 718 N UNIVERSITY RD
SPOKANE WA 99206
PARCEL NUMBE : 45163.0153
SUBDIVISION: KNOWN
LOT: BLOCK: 92 ZONE: AGSUB
F
GA
GA
PR
TO
INSPECTOR: FRANK P DICHUK
WATER DIST:
OWNER: PEARSON, KEN
PHONE: 509 928 5588
ADDRESS: 718 N UNIVERSITY
SPOKANE WA 99206
PROJECT NUMBER: 97010423
PERMIT USE: GAS LOG & PIPING
ISSUE DATE;
/03/97
APPLICANT: FALCO STOVE SHOP
PHONE: 509 926 8911
ADDRESS: 9310 E SPRAGUE AVE
SPOKANE WA 99206
CONTACT: FALCO STOVE SHOP PHONE: 509 926 8911
SETBACKS -> FRONT: N/A L T: N/A RIGHT: N/A REAR: N/A -
LENDER NAME:
PHONE:
0001$81
PERMIT(:) 1
/
i
MECHANICAL PERMIT
CONTRACTOR
►LC0 GARDEN CENTER INC
.ICENSE #: FALCOGC173DU
I LOG OR GAS INSERT 1
5 PIPING 1
)CESSING FEE 25.00
/�
FAL PERMIT FEE $36.00
S - 7 gl:"
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44,
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A .
P.
PAYMENT DATE
12/03/97
NT SUMMARY
RE' 1PT1f PAYMENT AMOUNT
$36.00
TOTAL FEES AMOUNT PAID AMOUNT OWING
$36.00
ISSUED PERMIT
$36.00 S.00
BY: BURRIS, ROBIN
NOTES