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Home My WebLink About403 CLARA ST_951754_2026 CITY OF ARLINGTON BUILDING DEPARTMENT GAS PIPING TEST AFFIDAVIT Homeowner gow o rJ - o 14 •g s-f- A� 1,rrR orb r Address 3 Permit No.9�_ l7551- The gas piping system was tested at 1cT psi for a total of a 0 minutes. WITNESSED BY (signature of occupant requesting gas service) (date) INSTALLED BY (signature of installing gas fitter) (date) Tease arrange for someone to be present on the date of requested inspection to provide access for the inspector. The white copy must be mailed upon completion to: City of Arlington - Building Department 238 N. Olympic Arlington, WA 98223 Hard Copy - Job Site Pink Copy - Contractor White Copy 7., Mail C TY OF:- ARL I NOYON CONSTRUCTION PE R M I T BERM I T NO. s: SM-17M4 Owner: GRABLE, HOWARD 403 N. CLARA 435-6578 Value of Works $2,726.00 Tax- ID: Describe Work: REPLACE OLD FURNACE WITH NEW Proposed Use: SFR Legal Description: Job Address: 403 N. CLARA Contractor's Name Type Address License# COZY HEATING G P.O.BOX 335 COZYHI*122MM P E R M I T F E E S Equipment and Fixtures Number Fee Total Charge --------------------------------------- ------ -------- ------------ FURNACE < 180,000 BTU 1 $9.00 $9.00 GAS PIPING 1-5 OUTLETS 1 $3.00 $3.00 WATER HEATER 1 $6.50 $6.50 S U B T O T A L..... . $1 A.50 TOTALS Fee Equipment $18.50 £ Mech Permit $15.00 SIGNATURE: TOTAL FEE................. $33.50 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND PAYMENTS..................50.41 KNOW THE SAME TO BE TRUE AND COR- RECT L PROVISIONS OF LAWS AND TOTAL DUE. . .. ... . ... . . . . . . $33.59 ORDI A CES GOVERNING THIS TYPE OF WORK W LL BE F PLIED ITH HETTER SP C F ED HE OR T. DATE RECEIPT # G BUI ING dF iFl CIAL MAY 12 1995 CITY OF ARLINGTON CONSTRUCTION PERMIT ❑ COMBINATION ❑ BUILDING ,a MECHANICAL ❑ PLUMBING ❑ SIGN PERMIT NO.17�- OWNE AIL AD/ ` / /D/RESS CITY Zrt G PHONE R ARCHITECT OR DESIGNER MAIL ADDRESS CITY 4 ZIP PHONE GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP q-?PHONE LIC NSE N 2l— ,-7 Awe A/.F_ . /�� csf�� 52�3 4-10y ,7/wrw MLCHANICALXONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE IF C0ONEWF WORK❑AUDITION ALTERATION ❑REPAIR ❑DEMOLI T ION ❑BUILDING RELOCATION Q VALUATION OF WORK Zs 279e� oo W DESCRIBE I K l 3 (/G / ><u m PRUPOSE USE OF BUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICA- W f TION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVI- Z LLGAL DESCRlPT1UN OF PROPERTY(SHOWN BELOW OR ATTACH FOUR COPIES) SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK J Lor BLLX:K OF WILL BE COMPLIED WITH WHETHER SPECIFIED HERIN OR NOT.THE i GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO W VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR F' LOCAL LAW REGULATING CONSTRUCTION OF THE PERFORMANCE OF a TAX ID NUMBER FROM PROPERTY TAX STATEMENT CONSTRUCTION.PERMIT EXPIRES 1 YEAR FROM DATE OF ISSUANCE. I Al URE OF CONTRACTOR OR AUTHORIZED AGENT DATE, V IOB ADDRLSS (OFFICE USE ONLY) HANICAL PLUMBING NO. TYPE OF FIXTURE PEE is FIXTURES NO. TYPE OF EQUIPMENT FEE x's FIXTURES ATBR CLOSET(TOILET) $7.00 tR COND.UNITS—H.P. EA. ti .list•• ATHTUB $7.00 tEFRIGOLATION UNITS—H.P.E.A. tip.list— FLY ASH BASIN $7.00 301LBRS—H.P.EA. 34%AP.list•• HOWER $7.00 3AS FIRED A.C.UNITS—TONNAGE EA tip.list*• TCHEN SINK R DISPOSAL $7.00 ORCED AIR SYSTEMS—B.T.U. MEA $9.00 ISHWASHER $7.00 ALL HEATERS—B.T.U. M S9.00 UNDRY TRAY $7.00 NIT HEATERS—B.T.U. M S9.00 LOTHES WASHER $7.00 APORATIVECOOLERS ATER HEATER $7.00 LOT"HES DRYERS $6.50 RINAL $7.00 ENTILATION FAN $450 KINKING FOUNTAIN $7.00 GE HOOD COMMERCIAL S630 LOOR DRAIN $7.00 M HANDLING UNIT— CPM ACUUM EIPMAKEItS $7.00 VB S630 OOF DRAINS—RAINLEADERS $7.00 13TAL FIREPLACE R CHIMNEY $650 INK(SERVICE—BAR,ETC. $7.00 ATER HPATER $650 ^ AS PIPING *(up to 5=$3.00,addnl.=S.75 y m meat list must be provided SUB TOTAL SUB TOTAL PERMIT PERMIT TOTAL FEE F-3 3 TOTALPEE PLAN CHECK FEE SIDL YARD SE IBACK STRLLT SLTBACK REAR YARD SETBACK PLAN CHECK NUMBER FEE RECEIPT NO USE /ONE LOT AREA VACANT SITE FEES VALUATION FEE ❑YES ❑NO PLAN CHECKING VG TYPE OF CONS] OCCUPANCY GROUP NO.OF DWELLING UNITS BUTDING S SIZE Ol BLLX,. NO,OF STORILS MAX.OCC.LOAD PLUMBING FIRESPRINKLERSREQUIRED ❑YES ❑NO MECHANICAL STATE BLDG.CODE COMMENTS ENERGY CODE SURCHARGE • ENALTY SEC.303(a) ATER/SEWERFEES TOTAL �,,,,MK�•..�. PERMIT VALIDATION �~ WHEN PROPERLY VALIDATED TIN THIS SPACE)THIS IS YOUR PERMIT&RECEIPT PAID CR# BY BUILDING OFFICIAL DATE cc: ASSESSOR,APPLICANT,TREASURER,BLDG. DEFT. RECORDS COPY