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� � <br />H <br />C � <br />H�� <br />k n <br />��� <br />Hy <br />x <br />o�d <br />��g <br />�V � <br />t"H� <br />g�y <br />n�� <br />�H� <br />HO[n <br />I <br />� <br />� <br />� <br />��� � <br />� � <br />��� 2320 Calilornia St., Everett, Washincton 98201 258-8211 <br />� ' Mailing Address: P. O. Box 1 f07, Everett, Washington 9Q206 <br />��- <br />Snohomish PUD Reference ONLY <br />Energy Plan Review #: O5�-C17 � <br />��NWEC" Plan Review and Compliance for Electric Heat Residences <br />Date• /(�''� y�' <br />Plan Check No: <br />Assessor's Property Tax Account No: <br />Jurisdiction Basic Plan #: <br />Builder: C� �.'NrloA Y(i6�i/�r' �'^ •, � Z^:� <br />Address• � ie� - - � ' � ��' <br />City: ii �:. b.7n- <br />Phone: � t ^ "'' <br />5ingle Family:_ <br />Multi-F:nily: ✓ Buildings:_L Units:_� <br />Site Address: [ 2 y ij ��` .� �' I � <br />Compliance: Chapter 4�-Systems At�alysis_, Ch�pter 5-Component Performance_Z( <br />Chapter 6-Prescriptive_, Chapter 7-Component Point_ <br />Note: See attached documentation /for� energy ref!quirements. <br />Snohomish County PUD nl Representative:,l���"'^ I" I'"- <br />Sign�ature � L Z <br />��f�h) %i • I.NI�E ZS�� 7 <br />Print Phone <br />+ITEMS BELOW ARE TO BE FILLED OUT BY THL <br />--------------------------- <br />Suilder / Consumer Payment � � ��� �� � <br />Owner or Authorized Agent: /� � ��-- ��/� � t� -'� -% <br />Signature <br />Mail Check To: <br />Name• <br />Addrese: <br />City, St <br />Tax Id.# <br />Note: An <br />NOR�T <br />ENERGY COD� <br />��Pi LICANT* <br />----------------------- <br />i'��-�•,i� /.�. C� /�.-,•,� <br />Print <br />Amount ; <br />or SS�: <br />IRS Form 1099 will be sent at the end of the year. <br />���� <br />GOai;,_C�e�s�` <br />������ <br />