1996, 01-29 Permit App: 96000471 Safety Inspect r A \,
PROJECT NtJMBE = 96000471 APPLICATION DATE= 01/29/96 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 10713 E 22ND AVE PARCEL#= 45282 .2908
ADDRESS= SPOKANE WA 99206
PERMIT USE= SAFETY INSPECTION FOR L. C. CARE FACILITY
PLAT#= 001393 PLAT NAME= KOKOMO TOWNSITE
BLOCK= 13 LOT= ZONE= UR 3.5 DIST#= F
AREA= 00000000 F/A= F WIDTH= DEPTH= R/W= 70
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST =
OWNER= SITTON, EARLENE PHONE= 509 928 7399
STREET= 10713 E 22ND AVE
ADDRESS= SPOKANE WA 99206
CONTACT NAME= EARLENE SITTON PHONE NUMBER= 509 928 7399
BUILDING SETBACKS: FRONT= NA LEFT= NA RIGHT= NA REAR= NA
******************************* BUILDING PERMIT ******************************
CONTRACTOR= OWNER PHONE=
NEW= REMODEL= ADDITION= CHANGE OF USE= X
DWELL UNITS= 1 OCCUP. LD= BLDG HGT= STORIES=
BLDG W X D = X SQ FT= SPRINKLER= N
REQ PARKING= #HANDICAP= CRITICAL MAT= N
ITEM DESCRIPTION QUANTITY FEE AMOUNT
STATE SURCHARGE Y 4 .50
CHANGE OF USE/SAFETY INSP Y 50. 00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
BUILDING PERMIT 54 .50 . 00 54 .50
54 .50 . 00 54 . 50
PROCESSED BY: JOHN LARSON
PRINTED BY: JOHN LARSON
******************************** THANK YOU ***********************************v
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LGFS PAYMENT DOCUMENT V YV``126
0008
Pv# SPOKANE COUNTY AUDITOR Change Ota#
Dept ORC
Bid ID
VENDOR: SHIP TO: BILL TO: Blanket#
S_ T 3 , EAi~LEME
Rc#
10713 E 22ND: AVENUE
EPnKANF WA 99206
VI#
Vendor Contact/Tel Confarr®p Order
FOB: PO DATE: BLDG/ROOM: BUYER
ACCTG.PERIOD: DELIVERY DATE: �, C i M O G A P k I G i WAREHOUSE:
COMMENTS• ENTERED BY` PURCHASING DIRECTOR-
COMM LN# DESCRIPTION
COMMODITY NO REF ACCT LINE QUANTITY 1 UNIT UNIT PRICE 1 TOTAL PRICE
PERMIT %000'71
�J
NO PERMIT WAS REQUIRED!
•
PAGE TOTAL: 54 .50
DISCOUNT TOTAL:
U .0C
FREIGHT TOTAL: w.00
SALESL TAX_ORDER
C.CC
':',t1RCH•" SE ORDER iALVE: S4.5C
USE TAX TOTAL: 0.0C
LINE NO. I FUND AGCY l ORG SB ORG ACT OBI SB OBI REV SRC SB REV I RPT CAT BS ACCT IOB NO. I PAX THIS AMOUNT P/F
.0 C
3tC
w . ».O
TOTAL TO VENDOR: c*+chi
RECEIVING CERTIFICATION PAYMENT CERTIFICATION TRAVEL CERTIFICATION
Materials noted in quantity ✓have been I`the undersigned do hereby certify under penalty of perjury that sufficient funds have been budgeted for this claim,the I hereby certify under penalty of perjury that this
received in goc condition or contracted for. aterials have been furnished,services rendered or labor performed as described herein or contracted for,that the claim is is a true and correct claim for necessary expenses
�// % a due and unpaid obligation against Spokane Countyor fund agencyindicated above,that I am authorized to authenticate incurredme and that no payment has been received
P ga !'A P by P Ym
SIGNED �f rilllrs G` nd certify tp said claim. , by me on account thereof.
TITLE Dry 1 H/96 S SIGNED TITLE OFFICE ADMINISTRATOR SIGNED TITLE
2/13/90 f 2 35
DATE DATE DATE PAGE
DEPARTMENT 2