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1998, 04-15 Permit 98002835 Refund7# apt REFUND M V0414 0018 u _5u — to IL_D L: PLAN ENDOR: ;POKANE FIREPLACE OKA W NEBOONE AVE endor Contact/Tel WA 99202 SHIP TO: LGFS PAYMENT DOCUMENT SPOKANE COUNTY AUDITOR Confirming Order BILL TO: PV MV04148001E Change Order # Bid ID Blankottl J RC# VIII FOB: PO DATE: BLDG/ROOM: ACCTG. PERIOD: 04 / 9 8 DELIVERY DATE: WAREHOUSE: CQMMENTS: ENTERED 13Y: PA T R IC IA f: I C K S T A D T pESOIpT I COMMODITY NO REF ACCT LINE 100%, rowi,-16,6T5 6, 243Q75-2835 SITE: 9219 E BROADWAY AVE SPOKANE WA r?"'>'" 99206 y QUANTITY UNIT BUYER____ PURCHASING DIRECTOR: D O N A L D L. LACUE UNIT PRICE PAGE TOTAL: DISCOUNT TOTAL: FREIGHT TOTAL: SALES TAX TOTAL: PURCHASE ORDER VALUE: USE TAX TOTAL: GRAND TOTAL: TOTAL PRICE 0.00 50.00 0.00 0.00 0.00 0.00 0.00 50.00 LINE NO, 04 FUND AGCY ORG 406 030 0008 SB ORG ACT OBI SB QBJ _REV SRC 2210 SB REV 07 RPT CAT BS ACCT JOB NO. PAY THIS AMOUNT 50.00 TOTAL TO VENDOR: 50.00 C1:SVI. CERTIFICATION PAYMENT CERTIFICATION '1'RAVEI. CERTIFICATION terialsIi in antity ✓ have been 1, 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 caved materla w fished, s rviecs rendered or labor performed as described herein or contracted for, that the claim is is a true and correct claim for necessary expenses allon again( Spokane County or fund agency Indicated above, 1ha1 1 not authorized to authenticate incurred by me and that no payment has been received INI by me on nceoum thereof, TITLE OFFICE ADMINISTRATOR SIGNED TITLE DATE PAGE P/F ACCOUNTS I'AVAIII 1 POKANE. COUNTY DIVISION hOF"$UII DING AND PLANNING 10261V. BROADWAY • SPOKANE, WA 99260-0050 (509) 456 3675 l SITE INFORMATION PROJECT INFORMATION SITE ADDRESS: 9219 E BROADWAY AVE SPOKANE WA 99206 PARCEL NUMBER: 45172.1226 SUBDIVISION: OPPORTUNITY SUB.TR.99 10T: BLOCK: ZONE: AGSUB INSPECTOR: FRANK PALADICHUK WATER DIST: OWNER: PASQUALE, JAN PHONE: 509 926 8694 ADDRESS: 9219 E BROADWAY AVE SPOKANE WA 99206 PROJECT NUMBER: 98002835 ISSUE DATE: 04/14/98 PERMIT USE: WOODSTOVE APPLICANT: PHONE: ADDRESS: SPOKANE FIREPLACE 509 326 7388 27 W BOONE AVE SPOKANE WA 99201 CONTACT: SPOKANE FIREPLACE PHONE: 509 326 7388 SETBACKS -> FRONT: N/A LEFT: N/A RIGHT: N/A REAR: N/A LENDER NAME: PHONE: ADDRESS: PERMIT(S) ) MECHANICAL PERMIT CONTRACTOR SPOKANE FIREPLACE LICENSE #: SPOKAFP033KL WOOD/PELLET STOVE/INSER 1 PROCESSING FEE 25.00 TOTAL PERMIT FEE $50.00 PAYMENT SUMMARY NOTES PAYMENT DATE RECEIPT# PAYMENT AMOUNT 04/14/98 00003474 $50.00 TOTAL FEES AMOUNT PAID AMOUNT OWING $50.00 $50.00 $.00 7 c c' C — . Sc (Z-UC-mow-Wb S agoD243 1. cry 4'14 g ISSUED PERMIT teo, le - BY: BURRIS, ROBIN