HomeMy WebLinkAboutS_Check_Request_Wetland MM_LUA14-000295_20220321AP Check Request Form
City of Renton ‐ Finance Department
1055 South Grady Way – 5th Floor
Renton, WA 98057
FinanceAP@rentonwa.gov
Instructions: This form is to be used for customer refunds, employee reimbursements, recording a payment made via Wire or EFT
__________________________________________________ ________________________________________
Requestor’s Name Ext. Requestor’s Department/Division
__________________________________________________ ________________________________________
Payable To Date
_____________________ _______________________________________________________________________
Detailed Check Description Total Check Amount
__________________________________________________________________________________________________
Address for Check City State Zip
Please check all that apply:
□Employee Reimbursement
□Customer Refund
□Wire/EFT Payments (If wire attach instructions)
□Other
_____________________________________________
Check handling instructions:
________________________________________________________
Emergency Check (outside normal check run)
Date Needed __________________________________
_______________________________________________________________________ _____________________
GL Account Number to Charge Amount
_______________________________________________________________________ _____________________
GL Account Number to Charge Amount
_______________________________________________________________________ _____________________
GL Account Number to Charge Amount
_______________________________________________________________________ _____________________
Signature Printed Name Date
Finance Accounts Payable Team
Natalie Wissbrod, Accounting Asst. Casaundra Sauls, Accounting Asst.
(425) 430‐6919 (425) 430‐6930
nwissbrod@rentonwa.gov csauls@rentonwa.gov
Jen Hughes, Finance Manager
(425) 430‐6935
jhughes@rentonw.gova
Check Information
Type of Check Request
Account Numbers
Approver Authorization (Department Administrator, Director, or designee)
BILLING INVOICE EG00124866
1055 South Grady Way, Renton, WA 98057
Transaction Date: March 21, 2022
AR:
Eden Invoice:
DEPARTMENT: System Administrator
BILLING CONTACT
Paul Ebensteiner
Lozier at Whitman Court LLC
1300 114th Ave SE, 100
Bellevue, WA 98004
REFERENCE NUMBER PAYMENT
METHODFEE NAME TRANSACTION
TYPE AMOUNT PAID
Check #93 Refund Finance APPlan LUA14-000295 Wetland - Install, Maintain & Monitor
- Cash
Bond Release
$52,125.00 3954 (650.000000.000.237.00.00.000)
$52,125.00
SUB TOTAL $52,125.00
$52,125.00 TOTAL
Page 1 of 1Printed On: March 21, 2022 Prepared By: Stacy Tucker
DATE:iJ/RECEIPT#::X’/’FINANCEREC.#:___________________________AMOUNT:$L,2t.jWO#:__________FUNCTION#:_______________TYPEOFDEPOSIT:BUILDINGD90DAYTEMPORARYOCCUPANCYPERMITCLANDSCAPINGMAINTENANCECSIGNDEPOSITCSTREETCLEANINGPUBLICWORKSDPWCONSTRUCTIONPERMITPROPERTYSERVICESCLATECOMERFEE(ToBERETURNEDTOLCSHOLDER)VCSWAC(APPRAISALFEEDUEAPPRAISER)BOARDOFPUBLICWORKSCBPWDEF(BPWDEFFERAL)(WO#89150FN#5190TANSCODE#7054)GOTHER:-l’ftYHt[ElSPECIALDEPOSITTRANSMITTAL1PAYEE:1:i?REFUNDINGADDRESS:A-vc%.iOCITY:iLLL.STATE:_____ZIP:_
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__PROJECTNAME:(+“(jiADDRESSLOCATION:_____________________________PERMIT#:_-(.‘1I4’.DEPT.CONTACT:____
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__SPECIALDEPOSITCONDITJONS:i-:ijc1k/i//li(‘J-;:;ék$i/).f)—/DMSo4SWWPSER\DEV&PtANNG’aLGDEPTFOPMD\SISCBUEDHGDOCSTEE.A1E5\SPEC.DEPOSrTWHITEANDYELLOWTOFINANCERETAINPINKFORPBPWRECORDS
RECEIPTEG00032141BILLINGCONTACTGARYSANFRIGLOZIERATWHITMANCOURTLLC1300114THAVESE,SUITE100BELLEVUE,WA98004-—,,
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.-.*TransactionDate:December30,2014Check#93PlanLUA14-000295Maintenance&Monitoring-CashBondPaymentjDheck#93$52,125.00SUBTOTAL$52,125.00TOTAL$52,125.00__
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__THISCHECKISLOZIERATWHITMANCOURT,LLC1300114THAVESE,STE#100BELLEVU,WA98004(425)454-8690DANDANARJ1FICIALWATERMARKONBANKOFAMERICA‘9314440SEEASTGATEWAYBELLEVUE,WA9800712/19/2014REFERENCENUMBERFEENAMETRANSACTIONPAYMENTTYPEMETHODAMOUNTPAID19-2/1250$*5212500SUMOFEXACTLYFIFTY-TWOTHOUSANDONEHUNDREDTWENTY-FIVEDOLLARSPAYTOTHEORDEROFCityofRenton1055SouthGradyWayRentonWA98055SIGNATUREHASACOLOREDNACEGROUND.BORDERCONTAINSMICROPSINtING