1984, 12-17 Permit: 00003739 Fireplace InsertSIGNATURE OF
OWNER OR AGENT DATE
APPLICATION
D' 12808 E BLOSSEY • AV
DwNER:
FOX. ELMER B
n°DRHH3:
12808 E BLOSSEY AV
Sr: Z.P:
°SPOKANE WA 99216-0000
(CANT.
HP VALLEY FIREPLACE.
<VALLEY FIREPLACE
HSS:
16610 E SPRAGUE AV
crtv: sr. Zip:
VERADALE WA 99037-0000
Nae s:
Pw509-922-2780 VALLEF*177CG
.w N,eND.NEEw:
ADDRESS:
C.TY, Sr: Z.P.
SSD!
P.275421630
Z
0999
.N BpE<rDw.
PL 000253
LDr & SLOG(
001 005
P.NAL
PLIJPPORTIJNITY TERRACE 3RD ADD
ZONH*. ZONE
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CO
D3FI.RPEPLACE INSERT
D' 12808 E BLOSSEY AV .
EH 0003964
D rH: 12/17/84
.wD.00003739
Mechanical. rep $20.00
PEES:
920.00
PAID DY.
C4°
X
CO
NC
CDUNrPLANSEXAM.
H r/v
. E'
° 12/17/8
MECHANICAL
PERMIT
' MECHANICAL TOTAL FEES $20.00
Processing fee Y Misc fee desc Amt $0.00 Pee: $10;00
Appl: Dry Si Range 0 Gaslog 0 Gas w/h 0 Solid Fuel. 01 fee: $10.00
OFFICE COPY
12-17.=8'4' • 877,6= *20006: