1992, 11-18 Permit: 92009935 Piping SPOKANE COUNTY I9EPARTMENT OF BUILDINGS
W.1303 BROADWAY AVENUE
SPOKANE,WASHINGTON 99260
(500456-3675
I certify that I have examined this permit/application,state that the information contained in it and submitted by me or my agent to compile said permit/application is true
and correct, and authorize Spokane County to proceed with processing. In addition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE
provisions included herein and agree to comply with same.All provisions of laws and ordinances governing this type of work will be complied with whether specified
herein or not.I understand that the issuance of this permit/application and any subsequent inspection approvals or Certificates of Occupancy shall not be construed to
give authority to violate or cancel the provisions of any state or local law regulating construction,or as a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OFAPPLICATION /L _ / r p 2
OWNER OR AGENT �'�' `� ?DATE %GKN
...:.....:.
PHONE NUMBER=
PROCEEEING FEE
SPOKANE COUNTY PAYMENT VOUCHER 132026
VENDOR RP--:}ND `; 11/18/9?
CODE ,�� DATE
RA's BIG+GEIS = AGENCY CODE r 17:J2rrr ;,=NT
NAME I NAME
3n1)?3 NORTH C+i l a1DN{ ROAD 1 ' AUDITORS STAMP
ix
ADDRESS i �,
C,1AT?1ZOY W.'\ 99nO3 1 - r� F.,
----z.,,, ,rqr�. 4� 1'141 i.Pr-ilk.-;:.V.,-11,IiE
ACCOUNT DISTRIBUTION, ORIGINATING ENTITY(ALL VOUCHER TYPES) 0 1099 REQ'D ID#
LINE VENDOR ORGAN- SUB REV SUB JOB REPT BS'
FUND AGENCY DESCRIPTION AMOUNT
NO. INVOICE NUMBER RACT OBJ RATION ACT SOURCE REV NUMBER CATEG ACCT
1 l'•2- P C,<': 5 /1 i.'" 0 3fl c.190.,'.; ',21C 07 iND 35.00
DETAIL DESCRIPTION
1 1011 TE:UND ON PETIT T #02 000n35 OR 1.5096 FAST 13TH AVF I, the undersigned do hereby TOTAL
: 35' l�';
certify under penalty of perjury
PERMIT IOTDED-TO BEISSUED BY STATE PER COPY n PERMIT ATTACHED
that sufficient funds have been
budgeted for this claim, the ma- TRAVEL CERTIFICATION
terials have been furnished, ser- I hereby certify under penalty of perjury
vices rendered or labor performed that this is a true and correct claim for
as described herein or contracted necessary expenses incurred by me and
for, that the claim is a just, due that no payment has been received by me
and unpaid obligation against on account thereof.
Spokane County or fund agency SIGNED
indicated above, that I am autho-
rized to authenticate and certify TITLE
INTRA-GOVERNMENTAL VOUCHER to said claim. DATE
SELLERS ACCOUNT DISTRIBUTION
ORGAN_ sub REVENUE sue RPT. oFwsET EXAMINED and ALLOWED
FUND AGENCY ACTIVITY REV JOB NUMBER RECEIVABLES
RATION ORG SOURCE SRC DATED- ACCOUNT
CERTIFICATION DATE 19
§161415.:::—.,- ``-- CHAIRMAN
SELLER CERTIFICATION "--`
I,herebycertifythat the materials have been furnished,the services 7' +I^c ''Om T ;c TP ATOR .
SIGNED TITLE MEMBER
rendered or the labor performed as described herein or contracted
for,and that the claim is a just,due and unpaid obligation,and that TITLE 1 i ,/c.:7
I am authorized to authenticate and certify to said claim. DATE DATE MEMBER