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Home My WebLink AboutCheck Request for Non-Vendor Refund June19CheckRequestlorNonVendorRefundorReimbursementThisformistobeusedonlyforonetimevendors.PleasecontactAccountsPayable;fyouhaveanyquestionsregardingonetimevendors.CheckwillbeincludedintheizextscheduledA/PclwekrunandmailedifterCouncilapprovalCheckRequestInfo:Dateofrequest:6/19/19Requestor‘sname.Requestordepartment/division:Requestor‘sext.#:ClarkCloseCED/Planning7289Payableto:NavixEngineeringMailaddressforcheck:II235SE6thStreet,SuiteI50;Bellevue,WA98004Accountnumber(s)tocharge:Amountperaccount#:000.000000.007.345.81.07.000$2,404.50Checkamount:$2,404.50Reasonforrefundorreimbursement:ChangeinLandUsepermittype-nolongerPUD,now2variancesandImodification,refundingthedifference.Checkhandlingrequest:Pleasemailcheckdirectlytopayee.Thanks*ApprovalSignature:RequestorDepartmentAdministrator,DivisonDirctoyrdesignee:Signature:c1JenniferHenningtypenameofsigneronabovelineDate:June19,2019*Thapprovingthischeckrequestmustbeanauthorizedsigner.DocumentiOnlineTypeableform,July2007 BILLINGINVOICEEGOO100235DEPARTMENT:SystemAdministratorAR:1055SouthGradyWay,Renton,WA98057EdenInvoice:BILLINGCONTACT0/0BruceGibsonOnTheRock94040LLC;ITFDEVELOPMENTSLLCP0Box50268Bellevue,WA98015REFERENCENUMBERFEENAMETRANSACTIONPAYMENTAMOUNTPAIDLUA19-000094PLAN-PreliminaryPUDFeeRefundRefundFinanceAP000000000007.345.87.07.000$(2,40450)($2,404.50)SUBTOTAL$(2,404.50)TOTAL$(2,404.50)Notes:CreatedByDateNoteStacyTucker06/19/2019ChangeinLandUsePermitType-nolongerPUD,now2variances&1Modification.PrintedOn:June19,2019PreparedBy:StacyTuckerTransactionDate:June19,2019Page1of1 RECEIPTEG00098947BILLINGCONTACTdoBruceGibsonOnTheRock94040LLC;ITFDEVELOPMENTSLLCP0Box50268Bellevue,WA980151055SouthGradyWay,Renton,WA98057TransactionDate:May02,2019REFERENCENUMBERFEENAMELUAI9-000094TRANSACTIONTYPEPAYMENTMETHODPLAN-EnvironmentalReviewFeePaymentCheckNumber:231997AMOUNTPAID000O0000000Z34581,04000$I54O00__________________$1,540.00PLAN-HEXSitePlanReviewFeePaymentCheckNumber:2319970000000000073458114000S3600OGPLAN-MasterSitePlanReviewFeePaymentCheckNumber:_________________2319970000000000073458114000$355800PLAN-PreliminaryPUDFeeFeePaymentCheckNumber:231997ooo0000000073458107000$514000$5,140.00TechnologyFeeFeePaymentCheckNumber:231997:43221000000$69400SUBTOTAL$694.00$14,532.00IUIMLiPrintedOn:June19,2019PreparedBy:DianaHiattPage1ofI RECEIPTEG00098948BILLINGCONTACTCIOBruceGibsonOnTheRock94040LLC;ITFDEVELOPMENTSLLCP0Box50268BeNevue,WA980151055SouthGradyWay,Renton,WA98057TransactionDate:May022019REFERENCENUMBERFEENAMETRANSACTIONPAYMENTAMOUNTPAIDLUAI9-000094PLAN-MasterSitePlanReviewFeePayment[CreditCard000.000000.007345.8f.14000$42.00‘.S4JSUBTOTAL$42OO]TOTAL$42.00REMAININGBALANCESasofJune19,2019Additionalfeesmaybeassessedduringtheplanreviewprocess.MODULECASENUMBERFEENAMEREMAIMNGBALANCEIPlanILUA19-000094IPLAN-PreliminaryPUDFee$24O4.9LUA19000094SUBTOTAL$240450JTOTALREMAIMNG$240450PrintedOn:June19,2019PreparedBy:DianaHiattPage1off