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��� <br /> A �a - <br /> ��� <br /> � <br /> Ho � /.;'J l ! �'c.r�ti�� /'�� <br /> � y� � r� <br /> x <br /> �d <br /> � v 2320 Cali�ornia Sf , EvPrett, Washin,qton 98201 2,58-821 1 <br /> ��g Maifing Address: P O. Box 1 f07, Everett, l��ashington 98206 <br /> Ey� <br /> ��+ Snohomish PUD Reference ONLY � <br /> g� Energy Plan Review #:fC'`1���4� <br /> t� <br /> O W <br /> � ��NWEC�� Pla� keviaw and Compliance for Electric Heat Residences <br /> Date• �� Z S - �l�' <br /> Plan Check No• <br /> Assessor'� Pr��Pz cy Ta�� l.ccount No: ��i'�� y'ti C`� <br /> Jurisdiction IIasic Plan q: <br /> IIuildeL•: � K �`�'� ,\ <br /> Address• �_ � <br /> City: <br /> Phone: 2, S` _ <br /> '�, Single Family:� <br /> Multi •i'amily: L�uildinys:.__ Units: <br /> �-� %� � � ��5,�� � �' �� �� <br /> site Tddress: L� Z L <br /> ' ' Compliance: Chapter 4-Systems Analysi,_, Chapter 5-ComFonent Performan� <br /> ��' Chapter 6-Prescriptive_, Chapter 7-Component Point_ <br /> ;;ote: See attached documentati�on7�fo. r encrg/y/requirements. <br /> ' 1 Snohomish County PUD #1 Representative: � ' ' � " �"'� <br /> ��' /f�� ^��l na!�Te � ���5 <br /> 1 Print Phone <br /> ! *ITEMS BELOW ARE TO IIE FILLED OUT BY THE APPLICANT* <br /> ' ---------------------------------- <br /> 1�� Bui.lder / C�nsumer Payment <br /> -� l�'!•F C. !I7'N� _ <br /> �� Owner or Authorized Agent� � � �int <br /> ' Signature <br /> � �% <br /> t4ai1 Check To: Amount $��5r_ __ <br /> i7ame:�-�'/C_ [.' /`��� ' <br /> A�3dress: ?C. C� , - -- . <br /> City, St. : . i . ��-�� -- <br /> Tax Id. N or SSR :_�� - � <br /> Note: An IRS Form 1099 will � be sent aY. the end oC thc year. <br /> .�'`'`•.�'�•'•,�- � r� . <br /> JORTHWEST C��� <br /> NERGY CODE " �' "` "�"' <br /> ��___. _ _. .. _ _ <br />