HomeMy WebLinkAboutS_Check_Request_MM_Release_LUA14-000190_20210429Document2 Online Typeable Form, July 2007
Check 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:
4/29/2021
Requestor’s name: Requestor’s department/division: Requestor’s ext. #:
Stacy Tucker CED/Planning 7282
Payable to:
Greenleaf - La Rosa LLC
Mail address for check:
12600 SE 38th Street, Suite 250; Bellevue, WA 98006
Check amount: Account number(s) to charge: Amount per account #:
$24,427.69 650.000000.000.237.00.00.0000 $24,427.69
Reason for refund or reimbursement:
Release per project manager, Brittany Gillia. Met the performance standards for the 5-year
maintenance and monitoring period for LUA14-000190.
Check handling request:
Please mail check directly to payee. CHECK MEMO: MAINTENANCE & MONITORING RELEASE
FOR LUA14-000190 GREENLEAF PLAT
*Approval Signature:
Requestor’s Department Administrator,
Division Director or designee:
Signature:
Vanessa Dolbee
type name of signer on above line
Date: April 29, 2021
*The person approving this check request must be an authorized signer.
BILLING INVOICE EG00115951
1055 South Grady Way, Renton, WA 98057
Transaction Date: April 29, 2021
AR:
Eden Invoice:
DEPARTMENT: System Administrator
BILLING CONTACT
Charles Conner
CHG SF LLC dba Greenleaf - La Rosa LLC
12600 SE 38th St, Suite 250
Bellevue, WA 98006
REFERENCE NUMBER PAYMENT
METHODFEE NAME TRANSACTION
TYPE AMOUNT PAID
CH 1866 Refund Finance APPlan LUA14-000190 Wetland - Install, Maintain & Monitor
- Cash
Bond Release
$24,427.69 3954 (650.000000.000.237.00.00.000)
$24,427.69
SUB TOTAL $24,427.69
$24,427.69 TOTAL
Notes:
Created By Date NoteStacy Tucker 04/29/2021 Release Maintenance and monitoring bond per project manager, Brittany Gillia. Satisfied
5-year monitoring period.
Page 1 of 1Printed On: April 29, 2021 Prepared By: Stacy Tucker
DATE:RECEIPT#t(fl4&LFINANCEREC.#:___________________________AMOUNT:$3gL,77MWO#:‘FUNCTION#:______________TYPEOFDEPOSIT:BUILDINGD90DAYTEMPORARYOCCUPANCYPERMITDLANDSCAPINGMAINTENANCEDSIGNDEPOSITDSTREETCLEANINGPUBLICWORKSDPWCONSTRUCTIONPERMITPROPERTYSERVICESDLATECOMERFEE(IQBERETURNEDTOLCSHOLDER)DSWAC(APPRAISALFEEDUEAPPRAISER)BOARDOFPUBLICWORKSDBPWDEF(BPWDEFFERAL)(WO#89150FN#5190TRANSCODE#7054)iOTHER:Ts:JHi.u‘i.’ycISPECIALDEPOSITTRANSMITTALPAYEE:iynktREFUNDINGADDRESS:)2LcCDSL•‘Ic2JCITY:iVL.STATE:ZIP:PROJECTNAMECFADDRESSLOCATION:/i.-PERMIT#:i_ut-a/4&iOiiCDEPT.CONTACT:!Lt&IExTN:‘742_ISPECIALDEPOSITCONDITIONS:,,...-I—‘—‘6/(1fi’(t—t(’rwiiflc.DMSIONSDEVELOPSER\DEV&PLAN.ING&DGDEPT.tOdSN5CBUCDP.GDOCS\TEI.WLATES\SPECDEPOSiTWHITEANDYELLOWTOFINANCERETAINPINKFORPBPWRECORDS_nI_tv
RECEiPTEG00044466—Renton€1?55SGradyWay,Renton,WA98057TransactionDate:October12,2015BILLINGCONTACTCHARLESCONNERCHGSFLLCdbaGREENLEAF-LAROSALLC3001MtnViewAveNRenton,WA98056VREFERENCENUMBERFEENAMETRANSACTIONPAYMENTTYPEMETHODOUNTPAIDCH1866PlanLUA14-000190Wetland-Install,Maintain&BondPaymentCheck#1866$24,427.69Monitor-Cash3954f650.000000.000.237.oQ.OO.000)$24,427.69SUBTOTALS24,42769TOTAL$24,427.69FACE DFTHDOCUMENTHASACOLOREDBACKGROUNDONWHEPAPERIGreenteaf-LaRosaLLCFoundationBankLU1\(t4\°La12600SE38thStreet,Suite250BE1evASO200Beltevue,WA9800698-8621425-455-92801251DATECHECKNO.AMOUNTOctober8,2015186642769Pay:*****Twenty4ourthousandfourhundredtwenty-sevendollarsand69centsPAYCityofRentonTOTHEORDEROFTHEBACKOFTHISDOCUMENTCONTAINSANARTIFICIALWATERMARK—HOLDATANANGLETOVIEW‘‘-I11EEZEZZPrintdOnflrtr,hnr199n1Prnrr1RrT,-kr1nf1