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- Act(vity/P�mit # <br /> NWE�; Lowrtse Residential Compliance Check Iist <br /> Electricall heated dwellln s, s 3 stories, Zone 1, Western Washin ton <br /> , ._.. .�:..; . 3 a.�,,: . ::3a:u.« � . ... <br /> FORM INSTRUCTIONS: Please read belore completlnp torm <br /> t FIII In all shaded infortnatlon boxes that apply to your pro�ect.IIn�Gt place marks In the two Ieft side <br /> colum�s tabeled"COMPLIANCE RE�UIRED" and "INSPECTION APPROVED". SinCe ihis form <br /> will be evaluated for compieteness,you can avold unecessary permit delays by carelully providing all <br /> required Inlormation. You may disregard Intormation requestes that don't addresa your paAicular <br /> building or equtpment. <br /> 2 ' Staff inembers wlll hetp wfin genaral questions about tilling out this form. However, it Is your <br /> reponslbility to provlde specific Inlormatlon for heating systems,glazing, Insulation, and other <br /> buildirp specillcatlons. For specific requtrements, reler to the Northwest Energy Code, 1987 Edition, <br /> This torm wili ultimately be the basis for all NWEC Ileld inspectfons. You can avold problems by <br /> seeking approval for any substitutions belore Incorporating them into the pro�ect. The buildinp official <br /> may require that you substantiale compliance claims about building producls or techniques by <br /> providlnp documentation trom approved testinp agencies or code authorities such as ICBO. <br /> 3 When your permit Is issued, you will recelve a copy ol this form. Boxes will be checked under <br /> "COMPLIANCE REOUIRED" Indicating NWEC requlrements that musl be incorporated Into this <br /> proJect. Each checked requlrement wlll be evaluated by the building Inspector and ,when deemed <br /> acceptabie, marked approved In ihe "INSPECTION APPROVED"column. <br /> ..,3,:23�Rne�2 ,: & F�A�.�.,.�, �i c{:rrt�. <br /> . . . . ._. , .: _ , ._:..... ;.:....:� .. � . . <br /> , -� .. �- a.<;: . .:a�. .., .. . :... .. . .. ...: .,. <br /> p 8; <br /> DATE - - � Ciry COUnIy � 'r� � ��'" <br /> NAME ` � BUILDING ADDRE33 � ` LOT M_ , <br /> ���n� <br /> BUILDINO TY E: COMPLIANCE PATH: <br /> �w Residentlal: ❑ Single Fam. ❑ C apter 6 (< 5000 Ft2) <br /> ❑ Remodel �'�Iul1i Fam. Componenl Perlormance Chq5 <br /> ❑ Addltion ❑ # Stories 2(s 3) ❑ Systems Analysis Chq 4 <br /> � Poinis System Chk7 <br /> . .. _. ._,:. e �_���.; nz� . �.�::r� � �. ;•,; ' <br /> ...�:, . . .; aS. �?<.*� a.� \ � <br /> ,��,:. . .v.. .�.... . •. �.:�x • .�:.. ,. - <br /> :<: <br /> Heating System Type: NOTE: All non•e/ectrlcally heated <br /> Eleciric: dwelllnpa musf comply wlth the <br /> OBase board �Forced air lurnace 188B Waahlnpfon Stafe Enerpy <br /> OHeat pump �ne heaters Code and ofher ordlnancea ol thls <br /> DOther )uHedlcNon. <br /> . kx� �:n•.:r-:s. .:c�.:.¢.x. xn. .�..x::�..c_. `! . . .-.;.._ . �'Z�ws:i��a� �����2%;:':. <br /> NWEC p18n fevleW: (Departmenl use oniy) <br /> �L�0 <br /> Approved by Date ,6 -,ri6 Jo <br /> Pago t of 7 <br />