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F <br />Date <br />Applicalion/Permil I <br />eu <br />Site Address. ....... <br />Assessor's Property Tax Account No. <br />-- --- -- ------ _ <br />DWRISE RESIDENT1 <br />E <br />SiteAddress ............. ........ 7�? .......... ... .............................. 1 ...................................... ...... <br />Owner's Address ..... ....... ................ .­ ...................... I ...... .....city .................................... Zip .................... Phone .................................. <br />Builder ......... Q CE F-) .. 7.-.) .... <br />t . ........... Address ....... �r 1.0 ...... ..... ......................... <br />City .......................... .......................................... Zip .... .............. Phone ...... 7?60 <br />... 1. ............. .................................... <br />Re T DESCRIPTION: <br />ew <br />(�tm <br />0 Addition <br />(x� <br />C) Remodel <br />0 Conditioned Sq. Fl..J <br />FUEL,=RCE: <br />HEATING SYSTEM TYPE: <br />0�[ieclric <br />0 Baseboard <br />0 Oil W wall heater <br />0 Gas 0 Furnace AFUE ................... <br />Single I of Stories ... ...... ........... <br />C Mufti -Family I of Units ........................ <br />0 Heat pump HSPF .............................. <br />0 Other ................................................. <br />0 Total Installed wan or BTU's ............ <br />Check one of the Compliance Option But$ below. Inserl the values into box number 4. Beloit completing this <br />section refer to the instructions on back at ton. <br />Electric - Northwest Energy Code, <br />Chapter 6 <br />0 Well Insulated Floor 0 S1lams Analysts <br />Option s pier 4 <br />; <br />0 Well Insulated Wall Component Performance, <br />s; <br />Option Chapter 5 <br />0 pass:,e Solar Option 0 Ccmpcqer.I Point System. <br />() Heat Pump Option Chapter 7 <br />FOR DEPARTMENT USE ONLY: <br />".mount of Payments ..................................... <br />Date Permit Issued ......................................... <br />Dale rarma Finaled ......................................... <br />I hereby certify that this dwelling was built in <br />compliance with the NWEC. <br />''­'*.... ien..... "'"' ........ budino off it <br />.... ........ . ...... <br />Dale <br />Other Fuel Sources - <br />Washington Slate Energy Code <br />0 Prescriptive Approach, <br />Chapter 6 <br />• Component Performance <br />Approach, Chapter 4 <br />• Systems An3lyrsis, <br />Chapter 5 <br />COMPONENT <br />Fiat Ceiling - <br />R... <br />Vaulted calk; <br />R <br />Wall <br />Below Gradc'ft: <br />interior <br />R ............ <br />exterior <br />R ........ . <br />Floor <br />Slab an Grade <br />Doors & Kme <br />Glazing <br />%Gluing <br />Air Leakage <br />0 a 0 0 6 0 0 * a <br />R-247 <br />R. - <br />Uj'vi? <br />UAV.0 <br />........... % <br />.... ...... % <br />OADV <br />I hereby Cerlifif that the Slolctufal panels will meet the NWEC Formaldehyde requirements -either the <br />HUD standards at muked nr- or -exposure I <br />Owner or Authorized Agent: <br />L <br />.................... .......... <br />.. ...... <br />Pont Name LL IL. <br />Signature <br />The local junsdichronyelecilic utility wit make a gmeril to either the builder at owe I lot new electrically <br />hated residences. Pcfmitmust beissUedbyI 31,91 and construction Failed 1 ('130,92 in order to <br />e jollowing information must he fillej <br />quality for payment. To fac,10:8 Payment. In cut 7P1eteIY_ <br />Mill Chojk 10: (pkjse p6nl) (ADD I Tj ONS/ RPMODI: LS NOT FI. I G! I L) <br />..... Fed. Tax 10 or SS#_'A._.. <br />`?'.................. 1...................I... ............................................... <br />City, ... ...................................... .) ..... . / . ....................... <br />Non <br />, I <br />