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. 1 <br />o�ie -�: o�.S.�t._��.! • � � <br />Applicatlon/Permi� / ---------------..._...._.-----....._ <br />Owncr__.mOt�.. .. ...._.........._.. ._......_._ -..........`..�............. <br />Sile Address __�.�.��4.rre.t�4�,�-����� 3 <br />V <br />lssessor's Property_7.ax_Account_No. <br />Site Address .........:.�'.l.d'�.......��.�:R�'�„�..�.�..�.�I.�U..........�.��.�. <br />Owncr's Address .................���............................... City.................................... Zip <br />Builder......................................................................... Address ...................................................... <br />; City .................................................................................................Zip <br />. <br />� e.tl:K1�1Y".l'�'ltu�f.'L�41�fi1 I'YL"C' tIJ 1tLltl0tilimRLY.' 4S .iVt?YC.J4M1mfi <br />� � � . .. <br />• <br />• .P,R,�OwJE�CT UESCflIPTION: <br />. urr+sw� �lion p <br />O Remodcl Cv-Cali�ilioned Sq. Ft.�../.�.... <br />� FUEI SOURCE: IIEATING SYSTEM TYPE: <br />6-E�drfc asebwrd <br />; O Oil O Wall hcalcr <br />. � �as ' Q Furnace AFUE ................... <br />. <br />• . �ec�^rsa:+sesas� <br />• <br />• � � � � � � � � � � � � � � � � � � � • <br />inple Famiy <br />O Mulli•Famiy <br />, . ...,aA2Es+..- <br />�N , O,Y ..0�:f : <br />. LOWRISE PESIOFNTIAL <br />� i �. i <br />;,:� .. <br />, .::��•. <br />'•.::,.: <br />.............. ...f--,�...-- ,`...,,,..�..�...�n..�. <br />/ al Stories...�:........... <br />/ of Units ......................... <br />O Neat pump HSPF .............................. <br />OOlher ................................................. <br />O Totai installed wans or BTII's ............ <br />• � � � � � � � � � � � � � � � � � � � � � � � � � � � � • <br />Check one al Ihe Campliance Option BoKes below. inseit the values inlo baz number 4. Beloie eomplelinp Ihis <br />seclian reler to Ihe instruc0ons an 6ock ol lartn. <br />Eleclric - Norlhwesl Enerqy Code, <br />Chaplor 6 <br />p Well Insulated Floor O Syslems Analysis, <br />Oplion Chapler 4 <br />p Weil Insulatr�.Wail omponent Periormance, <br />Oplion . C�aphS <br />O Passivre,Solar Optfon O Gertrycier.t Point Syslem, <br />rs,,,�e� � <br />���D B O x J <br />�IL��;D OUT ,�` <br />5/�u�r�. <br />,...:.:. .....::. ......:_�_.. ...�... .: <br />� D�le .. . .. . . . .. <br />Olher Fuel Sourcac • <br />Wa�hinqlan State Enerqy Code <br />� Prescriplive Approach, <br />Chapler 6 <br />O Componenl Pertormance <br />Approach, Chapter 4 <br />p Syslems Anaysis, <br />Chapter 5 <br />COMPONENT <br />FIa1 Ceilinp <br />Vaulled Ceilinq <br />Wall <br />8elow Grade Wall: <br />imerior <br />ezlerior <br />R............ <br />Fioor <br />SWb on Grade R. .,... , <br />Doors 8 Frame U......... <br />Gluinp /�. � , i <br />'�Glazinp �� .,'k <br />SolarAllowance ..........'ti <br />Air Lwkape O STD OADV <br />•••.•.•... <br />by artiH Ih�l lhe slructuril pmets wili mecl Ihe NI4EC Form�Mehyde requiremenls • eilher Ne <br />sl�nda�ds or nuiked'alerinr' ar'exposurc 1' .. <br />er or Aiilfiorlted Apant: <br />............................................................. ................................................................... <br />Nvne SlpniWre <br />I �urisdiction/eleclrk uGliy will m+ke � p�ymenl lo eitl�er lhe buiber or o�mer wdecldcof <br />r s. Permil musl Ce hsued 6y 17/31NI ond conslnxtlon finiled 92 in oNer lo <br />y lor p�ym . I�cili�le p�ymenl, Ihe lollovrinp inlorm�tlon muslbM� oul compktely_ _ <br />checklo:(plase0���� �ILL']ONS/RGP� NOl' GLIG[fSLC) <br />ess <br />uotF: �n �Ns foim I(r95 Mn ee unt,� m� ena N orz K,i. <br />