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��� <br />H <br />�Hy <br />H�N <br />�e c] <br />H 70 <br />'UH"�C <br />(q H <br />[�1 O � <br />H <br />OH <br />��g <br />�� � <br />t"y� <br />f�/� y <br />geti <br />�� <br />�Ht�i� <br />H O V� <br />Activity/P� mit # <br />FORM INSTRUCTIONS: <br />Please read bel�re completing torm <br />FIII In all shaded inlormalion boxes that apply to your ,�roJecL llnnot place marks In the two lett side <br />columns labeled " COMPI.IANCE R[DUIRED' and ",NSPECTION APPROVED". Since this form <br />will be evaluated lor completeness, you can avoid unecessary permit delays by carelully providing all <br />raquired Inlormat(on. You may disregard informalion r;que�tes lhat don't addross your particular <br />building or equipment. <br />Stali members will halp with general questions about Iiiling oul this lorm. However, it Is your <br />roponsibllity to provide specilic Inlormalion lor heating systoms, glazing, Insulation, and olher <br />building specilications. For specitic requirements, refer to Ihe Norlhwest Energy Code, 1987 Edition. <br />This torm will ultimately be the basls lor all NWEC ifeld inspeclions. You can avoid problems by <br />seeking approval lor any substitutions belore incorporating them into the project. The building oflicial <br />may require lhat you substantlate compliance claims about building prod�cts or techniques by <br />providing documentation irom approved testing agencies or code authorities such as ICBO. <br />OWhen your permit is fssued, you will receive a copy of this lorm. Boxes wid be checked under <br />"COMPLIANCE RECIUIRED' Indicating NWEC requiremonls that musl be Incorporated in�o lhis <br />�' § v< `� pro�ect Each checked requirement wiil bo evaluated by �ho building inspeclor and , when deemed <br />acceptable marked approved in Ihe "INSPECTION APPaOVED column. <br />.. . s� .as.s x <br />..em«m..c.r o..._.__..: ... .. .. ._ <br />� ` _ QCi�� CiOU�i�y .i %!lliilOc.../ fLl <br />y__—' <br />NAM � a f � BUILDING ADDRESS�����"' �' —LOT #— <br />�tJPr("/� � <br />BUILDING TYPE: �DMPLIANCE PATH: <br />❑ Now Residential: � Single Fam. ❑ Chapter 6(< 5000 Ft2) <br />-�`�(dditionl ❑# Stones ___ (s 3) ❑ Sys ems Analysis Chqe`ChpS <br />� Points System Ch#7 <br />Heating System Type: <br />i Etectric: <br />�� � Base board OForcetl air lurr,aco <br />l R OHeal pump �ne heaiers <br />� Other <br />NWEC plan revlew: (oepanmern uso oniy� <br />Approved by Date_ <br />NOTE: All non-elecfrically heafed <br />dwellings must comply wlth the <br />1986 Washingfon Sfete Enerpy <br />Code and ofher ord7nances of fhls <br />jurisd(cHon. <br />1 WE6SAP111Lf0 <br />�� J' <br />,�• �t-�aw <br />p -% <br />a - � �' � ?age 1 of 7 <br />�,�,2�y�� �;: � <br />