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