|
�� �
<br /> a
<br /> �HN
<br /> y �� � „ . � ' - :
<br /> . ja. �� � . ' . . .
<br /> _ .._.
<br /> �ey c] �ale... .' 1------�_..."—_--'-.. p
<br /> Mt Fti '�9 ADDlication/Perm�t/ __ ._.... ___----------- ._. ,. i(, P� .:... p •: .
<br /> .� �J � / atsioexTi�i
<br /> y Owncr_._. . � F��`!" _... 1�A lt�i1. . . .. ✓.�, Y� w i s .t
<br /> ., l0 E
<br /> y _. ..._ '� _ .. .._ ._ ,
<br /> ,,..
<br /> � , . .
<br /> �7. t J'� � L� V rl!tW.___e'1^'t_`. �u..cz� � ��' :;�
<br /> p � Si�eAddrzsa.._.)_�..._:..L__.._._h_� :.:;:.., ..
<br /> y :::.
<br /> ::... ,.
<br /> p H �Assessor's Pro ert .Tax.Account .No. ''�•�� �'�
<br /> _P. .Y -- ;:.
<br /> ��g --- ._.._ .. ._ %�� �i- ;� �:;��
<br /> � � �uo rin��k,,;view N��
<br /> 1—� H � '.N ,.�' ....................................
<br /> A y� � 58e Address.........................�.:...,h�.:.:'............................................ .............................................................................
<br /> t� � ;"NMF ......C' Zip....................Phone...................................
<br /> �JHH Owner'sAddress...................................................................... �ly.................................... , -
<br /> ^ . , ,
<br /> OyM � . �/�E. ��d/fc�l On/� `1•��� ...._�.A.y.!1.L'_�:�....kFrG.............4��.`..u:.�..............
<br /> Bwlder....:.. ...............h:.........n�.:........Address............./..7..�./. ,r
<br /> C)C7!A �..,.......:::..... .
<br /> . �iJ:..LL`
<br /> ......................................Zip....................................Phone................................................................
<br /> .
<br /> Ciry...............................................�o
<br /> H v� •
<br /> O p� .
<br /> •
<br /> • '"eaa'.."a�
<br /> • �-'
<br /> • PpOJEC70ESCflIPTION: /olStories..._f:.-�.......... �
<br /> ' b New �Addition , )/� l�li Sinple Famiy
<br /> � /of Units.........................
<br /> Q Remodel G Condi�ioned Sq.Ft...../..U........ O MuAi-Family
<br /> � FUEL SOUflCE: HFATINC SYSTEIA TYPE:
<br /> �¢Electrs O Base6wrd O Heat pump HSPF .............................
<br /> • O Oil .�"Wall hwter O Other.................................................
<br /> . O Gas O Furnace AFUE:................... O Total installed watts or BTU'n............
<br /> •
<br /> � �taawaaicmo
<br /> • • � � � � � � � � � . � � � � � � � � � • � � � � � � � • �
<br /> • � � � � � � � � � � � � � � � � � � � ��� •
<br /> �� ''��
<br /> ��i COMPONENT , �a
<br /> ' �� � ' ' � ' � flalCeilinp R..�........
<br /> � Vaul�ed Ceifrq R..... . ••
<br /> 1 ,
<br /> Check ane ol be Complunu Option Boxes below..me�Ne v:lues inla boK number 4.Belore comD�tlinp Ihis W,II R I q;:
<br /> , ,_� seclianreler�olhelnsuuctlonsanbxkolfarm. BelowGra7eWall:
<br /> L I a
<br /> � Eleelde-Xadhwe:l Enarpy Code, Olher Fuel Source�- In�erior R..._�.::...
<br /> � ChaD�er 6 Wuhlnqlon St�te Enerqy Code e�terior R............
<br /> � Q Well Insulaled Floor O Systems Anal�sis, O Prescriplive Approach, Floar A�•••••����-
<br /> ��� �_ pPqo� , Chapter 4 Chapter fi O
<br /> I Sub on Grade R..,(.... .
<br /> �� Q Well Insulated Wall �1�Companen�Pedormance, O Component Penormance Ooors 8 Fr�me U...r..rL.
<br /> Op�ion . Chapter 5 APDroach.Chapter 4 G�inq U...`'.G.
<br /> O PassNe Salar Option O Compenen�F'oint Syslem, O Systems Anatysis, y,Gluir,7 ������•••���
<br /> 1� O Hea�Pump Option Chapter 7 Chapter 5 Solar Allowance ..........'/e
<br /> __ Air Leakaqe ,�SiD OADV
<br /> �namrnm,sv+*..�rww�e�+rur • .
<br /> • � � � � � � � � •
<br /> ' �1_I - --- �
<br /> , . , . . , , , , ,
<br /> i FOfl UEPAHTMENT USE ONLY: .
<br /> i �'�lArtlouni o�Pay�ne�t E...................................... �here6Y utliN�t Ihe slructur�l D���'MII meet�e NWEC Farm�ldehyde�7����..cilher Ue
<br /> � HUD stmdaids oi nurked'extennf or'e�D�ure 1'
<br /> iOwnery�AulhonTad Aqenl: A
<br /> � Dal^Permil Issued......................................... (a�4Au?..�...�tcd�.'........... ... . .....: . �
<br /> ............................ pn�Wre
<br /> Pnnt Nvne p
<br /> DatePermitFna�ed......................................... nGi�:miidenus�^erm�imusi���sueebviT/719t1andconslnK�ofimkd yN3092enoNer�IN
<br /> awlity lor p�Ymenl.l���ciliWte D�Ymmt,Ihe I011awm0 infnrm+�on musl be filkd oul canDklely_
<br /> Ihere6ycertifythatthisdwellinp�webuiflin Mailchecklo:�v�es.eonop �:\I�:�I�I In'Jti/I:I�.t401�1-.1.ti ^;0'I� IiI,IGINL':)
<br /> cnmplunce wAh ihe NWEC. „__,_.,_ Fed.Tax ID ar 55/___..,.,. . ..
<br /> Name ____. ... . .. ......... . ...........
<br /> ..............._........................................................
<br /> BuiMinp011iw1almNonredApent Addrese...._..................._....._.._..._...............,.....................................................................
<br /> _...... CM... .............. Zip,..............._..._..................
<br /> .........................................._...
<br /> ....._�_......._ . .....................
<br /> ..................................................
<br /> Dlie _— a�m+a•.a:v .
<br /> __ ' " �(�'� �nILS{i"nl(KY1+'�NV^rd!F�I^A�""'rNlr
<br />
|