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��� <br />H <br />'Gi� �3 y <br />r <br />K c~] <br />H �1 <br />��� <br />�o� <br />H t7 <br />OH <br />��,g <br />�Y n <br />t"y� <br />Ny <br />g �' <br />n � y <br />�H[n <br />HOm <br />Q � <br />Ol %� <br />Activity/Pe. .�it # <br />FORM INSTRUCTIONS. �':; ', �Pleese read botore completlnp sorm ?����-''� >:i° <br />FIII in all shaded inlormatlon boxes that apply to your pro�ect. D.a�1 P�ace marks in Ihe i� �o lett side <br />columns labeled' COMPLlANCE REDUIRED" end "INSPECTION APPROVED". S(nce this form <br />will be evaluated lor completeness, you can avoid unecessary perm't delays by carelully providing all <br />required Information. You may disregard IMormalion requestes ihat don't address yoi�� parlicular <br />bwlding or equipment. <br />Stafi members will help with general questions about Iilling out ihis form. Howeve ,,a your <br />reponsibiiity to provide specilic Inlormation for heating systems, glazing, Insuialicn, and other <br />building specilications. For specilic requirements, refer to the Norihwest Energy Code, �987 Edition. <br />This lorm W�rovlalmor aln b ub,stitut oins betolre in Cpora�ling them Inlo the p oJect�Therbuild ng oilicial <br />seeking app Y <br />may requlre that yau substantlate compllance claims about bu��ding products or techniques by <br />providing documentation from approvecl testing agencles or c�de authorities such as ICBO. <br />When your permit is issued, you will receiv� a copy of this lorm. Boxes will be chocked under <br />'COMPLIANCE REDUIRED' indicalinfi NWEC requirements that musl be incorporated into this <br />oroJect. Each checked requirement will be evaluated by the building inspector and , whon deemed <br />acceptabls, marked approved in ihe "iNSPECTION APPROVED" column. <br />— . . .. ,�,,, <br />TE Clty _—Count <br />NAME BUILDING ADDRES <br />BUILDING TYPE: <br />� New <br />❑ Remodel <br />❑ Additlon <br />COMPLIANCE PATH: <br />Residential: C� Single Fam. �,,�/E'-X 9 <br />[] Multi Fam. I�y <br />[] k Slories_ (s 3) � <br />❑ <br />p- "�`-���-�-�- .: <br />��.;� > . _. .. �.>: <br />��� �s�Heating System Type: <br />Electric: <br />OBase board Forced air furnace <br />�Heat pump Zone heatnrs <br />[]Othor _ <br />Pl.WEC plan revtew: <br />;lpproved by <br />p— <br />Chapter 6 (< 5000 Ft2) <br />Component Porlormance Chtl5 <br />Systems Analysis Gh# 4 <br />Points System ChN7 <br />�"�`�' NOTE: All non-electrlcelly heated " � <br />i�cS s q c <br />��Y`�" dwellinga must comply wlfh fhe ',��. <br />1986 Washingfon State Energy <br />`y Code and other ordlnances o! thls <br />`-<= IUris�ctlon. <br />....:3.� i � <br />WEEB APHIL YO <br />uso only) <br />Date ppga 1 0l 7 <br />