HomeMy WebLinkAboutC_Refund_for_LUA17000169_signed_20170615_v1Check Request for Non Vendor Refund or Reimbursement
This form is to be used only for onetime 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:
6/15/2017
Requestor's name: Requestor's department/division: Requestor's ext. #:
Clark H. Close Planning Division 7289
Payable to:
Blue Fern Development, LLC
Mail address for check:
11232 120th Ave NE, Suite 204, Kirkland, WA 98033
Check amount:
Account number(s) to charge:
$1,500.00
000.000000.007.345.81.04.000
$3,500.00
000.000000.007.345.81.14.000
$750.00
000.000000.011.345.81.00.000
$172.50
503.000000.004.322.10.00.000
Reason for refund or reimbursement:
Amount per account #.-
$1,500.00
:
$1,500.00
$3,500.00
$750.00
$172.50
Applicant decided to shifting gears from Site Plan Review under LUA17-000169 and now is
pursuing a Preliminary Planned Urban Development and Preliminary Plat to obtain some
additional flexibility in the code. As a result, LUA17-000169 has been withdrawn. The new
corresponding LUA number is LUA17-000390.
Check handling request:
Mail check to payee.
Approval Signature:
Requestor's Department Administrator,
Division Director or designee:
Signature: '..
Jennifer Henning
type name of signer on above litre
Date: /� - / 20 ( q—
' The person approving this check request must be an authorized signer.
K:\Projects\2017\PR17000187_EARLINGTON TOWNHOMES\LUA17000169\Correspondence\Outgoing\C_Check_Request_ Refund_20170615_v1.docz Online Tpeable Form, July 2007