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� �j -'" � ,�2�j. Activity/� �rmtt # <br />FORM INSTRUCTIONS: <br />Pleaae read before completinp lorm <br />Fill In ail ahaded In(ortnetion boxes that apply to your proJect. �ppt place ma�Cs in the two �eit side <br />columns labeled' COMPLIANCE RE�UIRED" and 'INSPECTION APPROVED". Since this form <br />will be evaluated for compieteness, you can avoid unecessary pertnft delays I�y carefuily provfdinp all <br />required Information. You may disrepard IMormation requestes ihat don't address your partfcular <br />building or equipmeM. <br />Statt members will help wilh general questfons about fillfng out this form. However, it is your <br />reponsibility to provide specif(c information for heat(np systems, glazinp, insulation, and other <br />building specificatlons. For specific requirements, reler to the NoRhwest Enerqy Code, 7987 Edition. <br />This form will ultfmately be the basis (or all NWEC ffeld Inspections. You can avoid problems by <br />seekinp approval for any substitutions before incorporating them into the project. The buildinp ofticial <br />may require that you substaMiate compliance clalms about buildinp products or technfques by <br />providing documentation from approved testing agencies or code authorities such as ICBO. <br />3 When your permit is issued, you will receive a copy of this form. Boxes will be checked under <br />"COMPLIANCE REQUIRED" Indfcating NWEC requiremenis that must be tncorporated into this <br />proJect. Each checkeC requirement will be evaluated by the bufldinp inspector and , when deemed <br />acceptable, marked approved in the "INSPECTION APPROVED" column. <br />DATE �%7-`1oClty_L��� i7 County Sn��Jft-Y`�Isl1 � <br />NAME_6�ill�f=� �S��eUILDING ADDRESS�U/(o ✓ �%�a'�tJW/1'Y LOT N_ <br />BUILDING TYPE: <br />❑ New <br />�emodel <br />ddltion <br />COMPLIANCE PATH: <br />Resfdential: �Single Fam. Chapter 6(< 500r, Ft2) <br />❑ Multi Fam. Component Performance Ch#5 <br />❑# Stories_ (s 3) Systems Analysis ChA 4 <br />� Points System ChN7 <br />Heatlnp System Type: <br />Electric: <br />�Base board ❑Forced air fumace <br />�Heat pump �Zone heaters <br />�Other <br />NWEC plan revlew: <br />Approved by <br />use <br />Date <br />NQTE: All non•electrlcally heated <br />dwelllnpa must comply w/th the <br />1986 Washlnpton State EnerDy <br />Cod� and other ordlnences ol thls <br />Jurhdctlon, <br />WEEs APHIL Yo <br />Pege 1 oi 7 <br />