2002, 09-11 Permit: 02007735 RefundVoucher ID 00154089
Vendor ID HENDROOF
Invoice # PRJ#02-7735
Dept ID
VENDOR:
Henderson Roofing, Inc
1003 S Pines Rd
Spokane
Vendor Contact/Tel
WA 99206
SPOKANE COUNTY PAYMENT DOCUMENT
SPOKANE COUNTY AUDITOR
STIP TO:
BILL TO:
PAGE 1 OF 1
Rel Vchr
RC#
ENTERED DATE : 09/11/2002 PO DATE:
ACCTG. PERIOD: 09/2002
ENTERED BY: Laurie Carver
BUYER:
PURCHASING DIRECTOR: BELA G. KOVACS
LINE NO.
DESCRIPTION:
PO#
1
ITEM ID
CHG ORD#
PO LINE#
QUANTITY'
UNIT
UNIT PRICE'
EXTENDED AMOUNT
PO: SCHED#.
CONTRACT#
BLDG PERMIT OVERPAYMENT
0
0
1.0000
EA
0
23.86
23.86
LINE NO.
DISTRIB. LINE
ACCOUNT
FUND
DEPTID
PROGRAM CLASS
RPT CAT
BDP
ER PC UNIT PAY THIS AMOUNT
PROFILE ASSET •FLG
PROJA
PROJECT
ACTIVITY
RES. TYPE
CATEGORY
SUB CAT
AM UNIT
1
BACE
Comments:
1 36981 406 0300008
240 REFND
100% REFUND = PAID DOUBLE FEE TWICE - DIFFERENCE BEING RETURNED
PROJECT NO. 02007735 3426 S. WHIPPLE ROAD
2002
DISCOUNT TOTAL:
FREIGHT TOTAL:
SALES TAX TOTAL:
SUBTOTAL:
USE TAX TOTAL:
GRAND TOTAL:
TOTAL TO VENDOR:
N
ASSET ID
23.86
0.00
0.00
0.00
23.86
0.00
23.86
23.86
RECEIVING CERTIFICATION
Materials noted in quantity • have been received in good coodition or
contracted for.
SIGNE
DATE "7/D a . TITL
PAYMENT CERTIFICATION
1, the undersigned . o hereby certify under penalty of perjury that sufficient funds have been budgeted
f this claim, the rials have been furnished, services rendered or labor performed as described
claim is a just, due and unpaid obligation against Spokane County
or tun , that 1 am authorized to authenticate and certify to said claim.
SIGNED
DATE
TITLE
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
DATE TITLE
REQUISITION/PURCHASE ORDER DATA ENTRY
SPOKANE COUNTY PURCHASING SYSTEM
PAGE: 1 OF 1
DOCUMENT NUMBER
DATE: 9/11/2002 'ENTERED BY:
Laurie Carvof
VENDOR
CODE: HENDROOF-001
/
V1
VENDOR: HENDROOF
TOTAL COST
NAME: HENDERSON ROOFING
ADDRESS: 1003 S PINES ROAD
SPOKANE WA 99206
LOT
SHIP TO: BCE BILL ADRS/LOCATION:
SCE
REQUESTED BY: JIM MANSON
PHONE:
VENDOR CONTACT:
VENDOR PHONE/FAX:
ATTACHMENTS?
DOCUMENT NUMBER
DESCRIPTION
VOUCHER NO. 00154089
QUAN
CONFIRM?
DEPARTMENT: BUILDING AND CODE ENFORCEMENT
TOTAL COST
VENDOR CONTRACT/RESOLUTION it
RECEIPT #: DUE DATE:
VENDOR INV #:
REFUND
LOT
SHIP TO: BCE BILL ADRS/LOCATION:
SCE
REQUESTED BY: JIM MANSON
PHONE:
509-477-3675
ITEM
LINEA
ITEM
CODE
DESCRIPTION
QUAN
UOM
UNIT
COST
TOTAL COST
1
100% REFUND - PERMIT OVERPAID
1
LOT
$23.86
$23.86
2
3
4
PROJECT # 02007735 3426 5 WHIPPLE RD
5
6
FREIGHT
SUBTOTAL
TAX
TOTAL
0
$23.66
$0.00
$23.88
rrEM
LINEA
SCHED
LINE #
ACCOUNT
FUND
ORG
PROG
SUB -CLS
BY
PROJ/GRT
STATISTIC
ENCUMBRANCE
1
36981
406
0300008
2002
BACE
$23.86
PCUNIT
ACTIVITY
RTYPE
CATEGORY
SUB -CAT
AM UNIT
PROFILE ID
CAP
1 '"
PROJA
240
REFUND
2000
rv"
PCUNIT
ACTIVITY
RTYPE
CATEGORY
SUB -CAT
1
AM UNIT
PROFILE ID
CAP
P �
e rr e
-nR
PCUNIT
ACTIVITY
R TYPE
CATEGORY
SUB -CAT
AM UNIT
PROFILE ID
CAP
+x a
PCUNIT
ACTIVITY
RTYPE
CATEGORY
SUB -CAT
"=
AM UNIT
PROFILE ID
CAP
PCUNIT
ACTIVITY
R TYPE
CATEGORY
SUB -CAT
AM UNIT
PROFILE ID
CAP
`y
TOTAL
$23.86
BUDGET CE IFICATION 7
I hearbtcertify
SIGNED:
TITLE:
that s ent funds
7. been budgeted for this claim.
,`
THIS AREA FOR DEPARTMENT USE
(ADDITIONAL APPROVALS, ETC.)
PURCHASING EXCEPTION #27 - REFUNDS
DATE:
Purchase Order Data Entry Buyer Worksheet
Page 2 of 2
9/11/2002
�_SlnwvrkComa
SPOKANE COITNTY DIVISION OF. BUILDING
AND CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE °SPOIKANE, WA 99260-0050
J
Site Information Proje t Information
Site Address: 3426 S WHIPPLE RD
SPOKANE, WA 99206
Parcel Number: 45331.3305
Subdivision: MIDILdME4TH ADD
Block: Lot:
Zoning: UR -3 Urban Residential 3.5
Owner: KNUDTSEN, VERN
Address: 3426 S WHIPPLE RD
SPOKANE, WA 99206
Building Inspector: DAN HOWARD
Water Dist:
Project Number: 02007735 Inv: 1 Issue Date:
Permit Use: RE -ROOF RESIDENCE
Applicant: FIENDERSON ROOFING INC
1003 S PINES RD
SPOKANE, WA 99206
Contact: HENDERSON ROOFING INC
1003 S PINES RD
SPOKANE, WA 99206
Setbacks - Front: Left: Right:
Group Name:
Project Name:
9/10/02
Phone: (509) 370-8199
Phone: (509)370-8199
Rear:
1
Permits
Building Permit Contractor:
Remodel
Dim: X Stories
Sq Ft:
Grp:
Type:
HENDERSON ROOFING & CONST INC
License #: HENDERC995MS
RE -ROOF R-3
VN 0
Total Value: $3,150.00
FOR BUILDING INSPECTIONS CALL (509) 477-3675.
RESIDENTIAL VALUATION
INVESTIGATION FEE
STATE SURCHARGE
RESIDENTIAL SURCHARGE
Total Permit Fee:
$88.00
$88.00
$4.50
$19.36
$199.86
Payment Summary
Total Fees AmountPaid AmountOwing
$199.86 $199.86 $0.00
Processed By: BURRIS, ROBIN
Printed By: WENDEL, GLORIA
Tran Date
9/10/02
Page 1 of 1
Receipt #
6990
Payment Amt
$199.86
PERMIT
a
Project Receipt Summary Tuesday,September 17,2002 Page 1 of
Address 3426 S WHIPPLE RD PROJECT#: 02007735
Owners Name: KNUDTSEN,VERN Phone: (509)000-0000
Address: 3426 S WHIPPLE RD
SPOKANE,WA 99206
Occupant: Phone:
Applicant: HENDERSON ROOFING INC Phone: (509)370-8199
Use: RE-ROOF RESIDENCE
Application Date: 9/9/2002 Permit Issue Date: 9/10/2002
Receipt Nbr: 6990 Transaction Date/Time: 9/10/2002 1:53:15 PM
Acct Account Transaction
Description Total Due Amount Paid
00120 RESIDENTIAL PMTS P $76.76 $76.76
P0170 INVEST. FEE P $25.08 $25.08
00170 INVEST. FEE P $62.92 $62.92
P0120 RESIDENTIAL PMTS P $30.60 $30.60
00150 STATE SURCHARGE P $4.50 $4.50
$199.86 $199.86
Tender Type Amount Paid Payer
Checkl $223.72 HENDERSON ROOFING INC
IE Cashbox Summary ��
Receipt Finder 7033 Date 9/11/2002 12.59:06 PHA E-__._____.._,
Opening Cask $0 00
Net Tendered: ($23.86)
Cashbox ID 5 J Open Date/Time: 9/11/2002 12:53.10 PM J ! CASH COUNT: ` ($23-86)
Name Accounting-LC Close Date/Time: 9/12/2002 8;20 14 AM r Closed
Tender Summary Deposit Summary Journal I Locations 1 eeeeeeeeeeeeRepoq
Rcpt Nbr MU Date/Time 9/11/2002 12-59 06 PM User ID Lcarverl Tran Type: Refund
Trans.-themDefasd„ lend wvatx
Proj/Comm Inv Acct Desc Tran Amt ji Type Doc Tender
K Checkl PPS 154089ID ($23.86)
si
.___._ __ -__-,____ Net Tendered ($23.06)
Total Projects:
Change: $0.00
Net Tendered: ($23.86) ,
Reason: OVERPAYMENT BEING REFUNDED.
LSC
Total Misc
Tran Over/(Short)- ($23.86)
Net Transaction: ($23-86) i
Refunded w/ PPS voucher# 154089 by L. Carver for$23.86.
FrriiP yrnenl_fis fund "�"f ff s m
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t. �, 1� gw 1•� _PD DSL FEE T1 fICE. ,
` :'...',-:''ii...;..,...,.,*.'''' '',.. :.� ;G WIENDEL REFUND DIF. f.:
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'il �Oti � $23.86 :.•....'....:::!:1::,]'•Ctr PPS 15 089 • ..
i •• .Nari DVERPAYMENT BEING REFUNDED. L5t -i 1 t
i
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