HomeMy WebLinkAbout18506 WOODBINE DR_951882_2026 CITY OF ARLINGTON BUILDING DEPARTMENT
GAS PIPING TEST AFFIDAVIT
Homeowner I �
Address 4-) Permit No.
The gas piping system was tested at. ps[ibr a total of 6 a minutes.
WITNESSED BY _ 7G-
(signature of occupbAt requesting gas service) (date)
INSTALLED BY - � -)" — Id l 9 / py
(signature of installing s fitter) (date)
Please 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 - Mail
G I TY OF A RL I NGTON
CONSTRUCTION RE R M I T
F31E RM+H I T NO- : S tS-1 aS2
Owner: JIRA, JIM 18506 WOODBINE DR ARLINGTON 98223
Value of Work: $1,500.00 Tax ID: Phone: 435-8732
Describe Work: GAS FREESTANDING STOVE
Proposed Use:
Legal Description:
Job Address: 18506 WODDBINE DR
Contractor's Name Type Address License#
COZY HEATING M P.O.BOX 335 COZYHI*122MM
P E R M I T F E E S
Equipment and Fixtures Number Fee Total Charge
FURNACE < 1007000 BTU 1 $9.00 $9.00
GAS PIPING 1-5 OUTLETS 1 $3.00 $3.00
S U B T 0 T A L..... .
TOTALS Fee
Equipment $1 .00 //�� ��
Permit Fee 15.00 x
SIGNATURE:
TOTAL FEE.... .... . ... . . . . . $27.88 I HEREBY CERTIFY THAT I HAVE READ
AND EXAMINED THIS APPLICATION AND
PAYMENTS...... .. ..........$0.0 KNOW THE SAME TO BE TRUE AND COR-
RECT ALL PROVISIONS OF LAWS AND
TOTAL DUE........... .... .. $27.00 ORDINANCES GOVERNING THIS TYPE OF
WORK WILL BE COMPLIED WITH WHETHER
SPECIFIED HER OR T.
DATE RECEIPT # c;�gC-o
PAID �,�n BUILDII� OFFICIAL
0�u T 10 1995 C�
CITY OF ARLINGTON
CONSTRUCTION
PERMIT
❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN
PERMIT NO.
j OWNER MAIL ADDRESS rCilY ZIP PHONE
CGZJZzZS E13 7 -212-
A CHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE
GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LIC NSE 0
MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE/
C��loL/G�Z i'1�1J2,2"nr1
P UMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE/
3 CLASS OF WORK
¢ NLW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑BUILDING RELOCATION
QvALUAT ION OF WORK
W DESCRIBE WORK
Co PROPOSE O USE Of BUILDING
en 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICA-
w TION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVI-
� LEGAL LAMRIPTIONOf PROPERTY(SHOWNBELOWORATTACHI'OURCOPIES) SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK
LUr BLOCK • OF WILL BE COMPLIED WITH WHETHER SPECIFIED HERIN OR NOT.THE
a GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO
w VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR
TAX ID NUMBER FROM PROPERTY TAX STATEMENT LOCAL LAW REGULATING CONSTRUCTION OF THE PERFORMANCE OF
IL CONSTRUCTION.PERMIT EXPO FROM\ DATE OF ISSUANCE.
QSIGNATRA RAUTHOgIZE NT DATE
V♦ 108 ADDRESS
�l-� x b
(OFPICE USE ONLY)
PLUMBING ECHI.1ICAL
NO. TYPE OF FIXTURE FEE :'a FIXTURES NO. TYPE OF EQUIPMENT FES :'a FIXTURES
ATER CLOSET TOILET 37.00 IR COND.UNITS—H.P. EA d .Ilt—
ATHTUB $7.00 111FRIGERATION UNITS—H.P.EA d .Rt-
VATORY ASH BASIN $7.00 30ELERS—H.P.BA d .Bt•"
HONRER $1.00 3AS FIRED A.C.UNITS—TONNAGEEA d .lit-
TCHEN SINS&DISPOSAL $7.00 7ORCED AIR SYSTEMS—B.T.U. 3 S Y-MEA $9.00
1SHWASHER $7.00 NALL HEATERS—B.T.U. M S9.00
UNDRY TRAY $7.00 JNIT HEATERS—B.T.U. M $9.00
LOTHES WASHER $7.00 73VAPORATIVECOOLERS
ATER HEATER $7.00 2LOTHES DRYERS $6.50
RINAL $7.00 eENTILATION FAN $430
RINIUNG FOUNTAIN $7.00 LANGE HOOD COMMERCIAL $630
LOOR DRAIN S7.00 OUR HANDLING UNIT— CPM
ACUUM BREAKERS $7.00 MO VE 8630
OOP DRAINS—RAINLEADERS $7.00 E'TAL FIREPLACE&CHIMNEY S630
INK SERVICE—BAR,ETC. $7.00 WATER HEATER S630
AS PIPING *(up to S=$3.00.addnl._SJS
—Equipment lid mut be provided
SUB TOTAL SUB'TOTAL
PERMIT PERMIT
TOTALFEE TOTALPEE
SIDL YARD SE I BACK STREET SL TBACK REAR YARD SETBACK PLAN CHECK NUMBER PLAN CHECK FEE
FEE �� C7v RECEIPT NO
USE /ONI LOT AREA VACANT SITE (.
❑YES ❑NO FEES VALUATION FEE
TYPL Of CONS OCCUPANCY GROUP NO.OF DWELLING UNITS PLAN CHECKING VG
f
SILE Uf BIOL,, NO.Or STURILS MAX.OCC,LOAD BU'LDING
PLUMBING
FIRE SPRINKLERS REQUIRED
❑YES ❑NO MECHANICAL
COMMENTS STATE BLDG.CODE
ENERGY CODE SURCHARGE
PENALTY U.B.C.
SEC.303(a)
WATER/SEWER FEES
TOTAL
PERMIT VALIDATION
WHEN PROPERLY VALIDATED TIN THIS SPACE)THIS IS YOUR PERMIT 6 RECEIPT
PAID CRO BY
cc:ASSESSOR,APPLICANT,TREASURER,BLDG. DEPT BUILDING OFFICIAL DATE
RECORDS COPY