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11731 AIRPORT RD LA PALMERA RESTAURANT 2019-10-30
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LA PALMERA RESTAURANT
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11731 AIRPORT RD LA PALMERA RESTAURANT 2019-10-30
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Last modified
10/30/2019 2:57:09 PM
Creation date
10/30/2019 2:55:43 PM
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Template:
Address Document
Street Name
AIRPORT RD
Street Number
11731
Tenant Name
LA PALMERA RESTAURANT
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V.0,01fr 0(g0 <br /> rg S OHOMISH Payment Due 10 Days from Invoice Date <br /> / HEALTH DIS RI T Pay Online©www.snohd.ora or Make Checks Payable to Snohomish Health District <br /> www.SNOHD.ORG <br /> Applicant information: Account ID Invoice Date Invoice ID Amount Due <br /> HECTOR MENDOZA AR0035464 = [ 5/24/2019 • 1 IN0043433 $315.00 • <br /> 1717 S LAKE STICKLNEY D <br /> LYNNWOOD WA 98204 <br /> Hector M Mendoza <br /> 1717 s lake Sticklney dr <br /> LYNNWOOD,WA 98204 <br /> PLEASE RETURN THIS INVOICE NOTICE WITH PAYMENT <br /> Invoice ID : IN0043433 <br /> Date Program/ Description PTA Lot# Installation Address Record ID Amount <br /> Element <br /> 5/24/2019 5685 PLAN REVISION SR0015024 185.00 <br /> ALTERATION TO <br /> 5/24/2019 9999 PAYMENT(CREDIT) SR0015024 -185.00 <br /> 6/10/2019 9992 CHARGE SR0015024 -185.00 <br /> REVERSAL <br /> 6/10/2019 5672 GENERAL FOOD SR0015024 500.00 <br /> PLAN REVIEW <br /> Total Due for This Invoice: $315.00 <br /> 3020 Rucker Avenue,Suite 104■Everett,WA 98201-3900■fax:425.339.5254 IN tel:425.339.5250 <br /> e,00r, Page 1 of 1 <br />
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