1995, 10-27 Permit: 95008944 Insert, Piping- SPOKANE 'COTJN']CY DEPARTMENT OF BunDINGS
WEST 1026 ' BROADWAY • SPOKANE, WA 99260-0050
(509) 456-3675
SITE INFORMATION
SITE ADDRESS: 11614 E 36TH AVE
SPOKANE WA 99206
PARCEL NUMBER: 45331.1102
SUBDIVISION: MIDILOME IST ADD
LOT: 2 BLOCK: 3 ZONE: UNKN
INSPECTOR: FRANK PALADICHUK
WATER DIST:
OWNER: STEWARD, JEFF
PHONE: 509 927 8752
ADDRESS: 11614 E 36TH AVE
SPOKANE WA 99206
PROJECT INFORMATION
PROJECT NUMBER: 95008944 ISSUE DATE: 10/27/95
PERMIT USE: GAS FIREPLACE INSERT & PIPING
APPLICANT: STEWARD, JEFF
PHONE: 509 927 8752
ADDRESS: 11614 E 36TH AVE
SPOKANE WA 99206
CONTACT: JEFF STEWARD PHONE: 509 927 8752
SETBACKS -> FRONT: NA LEFT: NA RIGHT: NA REAR: NA
LENDER NAME:
PHONE:
ADDRESS:
PFRMIT(S)
CONTRACTOR
OWNER
LICENSE 0:
GAS LOG OR GAS INSERT 1
GAS PIPING 1
PROCESSING FEE 25.00
TOTAL PERMIT FEE $36.00
PAYMENT SUMMARY NOTES
PAYMENT DATE RECEIPT# PAYMENT AMOUNT
------------ -------- --------------
10/27/95 00010479 $36.00
TOTAL FEES ANDUN T PAID AMOUNT OWING
------------- ------------ -------------
$36.00 $36.00 $.00 FILE
ISSUED PERMIT BY: JULIE SHATTO
Stove ShoP
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9310 E. SPRAGUE AVENUE
SPOKANE? WA 992C`
Vendor Cordacl/Tel
LGFS PAYMENT DOCUMENT M v 10 313 0 010
SPOKANE COUNTY AUDITOR Change Order #
Cord rmbg Order
BILL TO:
Bid ID
Blanket#
RC#
VI#
FOB: PO DATE: BLDG/ROOM: BUYER
ACCTG. PERIOD: DELIVERY DATE: WAREHOUSE:
COMMENTS- ENTERED BY-- PURCHASINQ DIRECTOR -
COMM LN# I DESCRIPTION
COMMODITY NO REF ACCT LINE QUANTITY UNIT UNIT PRICE TOTAL PRICE
9 5 0 0 867 0- 11614 E 36TH - DUPLICATE PONIT 10% REQ'..
DUPLICATE TO #95008944
36*GU
PACE TOTAL: 360GO
MISCOUNT TOTAL: 0#00
FREIGHT TOTAL: O.UO
SALES TAX TOTAL: 0*00
PFJ--'7HASE ORDER VALUE: 36.00
USE TAX TOTAL: 0000
Irl- -TT ± =[
FLING NO FUND I AGCY ORG SB ORO ACT OBI SB OBI REV SRC SB REV ( RPT CAT BS ACCT TOB NO. PAY THIS AMOUNT P/F
.JOaI.'v
RECEIVING CERTIFICATION
Materials noted in quantity ✓ have been
received in good condition or contracted for.
SIGNED
TAP 1 ECR 3
DATE 11/1/95
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 I am authorized to authenticate
and certify to said claim. t� ADMINISTRATOR
ty,� p�ttT ry�
SIGNED TITLE OFFICE ADMINISTRATOR
DATE 11/ /95
DEPARTMENT2
TOTAL
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
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