HomeMy WebLinkAboutBoun SP - Refund Form - Check RequestCheck Request for Non Vendor Refund or Reimbursement
This form is to be used only for one time vendors. Please contact Accounts Payable if you have
any questions regarding one time vendors.
Check will be included in the next scheduled A/P check run and mailed after Council approval.
Check Request Info:
Date of request:
November 16, 2018
Requestor’s name:
Requestor’s department/division:
Requestor’s ext. #:
Brianne Bannwarth
CED/Planning
7299
Payable to:
Socheat Khnor
Mail address for check:
Attn: Socheat Khnor
26721 106th Avenue SE
Kent, WA 98030
Check amount:
Account number(s) to charge:
Amount per account #:
$90,519.85
406.000000.018.343.50.03.000 ENG - SEWER - Initial
406.000000.018.343.50.03.000 ENG - SEWER - Actual
405.000000.018.343.40.03.000 ENG - WTR - Actual
000.000000.007.322.10.06.000 ENG - Street Light Connections
000.000000.007.322.40.00.000 ENG - Right of Way
405.000000.018.343.40.04.000 ENG - WTR - Test - Water Quality/Purity
405.000000.018.343.40.04.000 ENG - WTR - Main - Connection
405.000000.018.343.40.04.000 ENG - WTR - Chlorination
305.000000.016.345.81.01.000 ENG - Sidewalk Impact Fee/Fee in Lieu
426.000000.018.379.10.00.000 ENG - SEWer - FSDC - Total
425.000000.018.379.10.00.000 ENG - WTR - FSDC - Total
427.000000.018.379.10.00.000 ENG - Storm - FSDC - SF
407.000000.018.343.10.03.000 ENG - Storm - Actual
000.000000.007.341.82.00.000 ENG - Roadway -Initial
000.000000.007.341.82.00.000 ENG - Roadway - Actual
$281.03
$942.12
$1,171.84
$400.00
$120.00
$384.00
$1,284.00
$218.84
$19,593.20
$19,859.00
$26,089.00
$12,026.00
$5,029.68
$1,219.66
$1,901.48
Reason for refund or reimbursement:
Permit: U16006297
Project: Civil Construction Permit for the Boun Short Plat
Address: 1012 Duvall Avenue NE
Reason: Permit cancelled prior to start of construction.
Check handling request:
Please mail a copy of this check request with the check.
*Approval Signature:
Requestor’s Department Administrator,
Division Director or designee:
Signature:
Brianne Bannwarth
type name of signer on above line
Date:
November 16, 2018
*The person approving this check request must be an authorized signer.