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Receipt No.: R06 -02007 <br />Payee: DALE B NELSON <br />City of Tukwila <br />Department of Community Development <br />6300 Southcenter Boulevard, Suite #100 <br />Tukwila, Washington 98188 <br />Phone: 206 -431 -3670 <br />Fax: 206 -431 -3665 <br />Web site: http: //www.cLtukwila.wa.us <br />RECEIPT <br />Parcel No.: 0223200052 Permit Number: D06 -456 <br />Address: 411 STRANDER EL TURIN Status: PENDING <br />Suite No: Applied Date: 12/01/2006 , <br />Applicant: OBJECTIVE MEDICAL ASSESSMENTS CORP Issue Date: <br />Initials: JEM Payment Date: 12/22/2006 10:40 AM <br />User ID: 1165 Balance: 50.00 <br />TRANSACTION LIST: <br />Type Method Description Amount <br />Payment Cash 61.35 <br />ACCOUNT ITEM LIST: <br />Description <br />BUILDING - NONRES <br />STATE BUILDING SURCHARGE <br />Account Code Current Pmts <br />000/322.100 56.85 <br />000/386.904 4.50 <br />Total: $61.35 <br />Payment Amount: 561.35 <br />• <br />• <br />• <br />• <br />3021 12/22 9716 TOTAL 61.. -3 <br />doc: Receiot -06 Printed: 12 -22 -2006 <br />