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� . � 2004 Washin lon Stale Nonresidential Ene Code Com liance Fortn <br /> 200a Y:as�ington Slale NonreSiEen;iai Energy Cotle Compi�ance Forms RewSeE May 2005 <br /> Project Info ProjettAddress qg70 cvezyreen wey Date 8/18/200a <br /> ¢vecett, Meahing[on For Building DepL Use <br /> AppI1C201N8m8: 5[aplee - Shell Amentlment �Q�O ` _VL� , <br /> Applicant Address: <br /> Applicanl Phone: <br /> Pruject Description Packeged gas/electric rooftops with concentric supply/return diffuser <br /> BrieflydescribemeGian;cal or ducted supply and return plenum, air side economizers, controlled <br /> system rype and features. by EMS SySt0f11. <br /> �Indudes Plans Drawings musl wnlain noles requireing compliance wilh commissioning requiremenls-Sec6on 1416 <br /> Compliance Option �Simple Syslem O Complez System Q Systems Analysis <br /> (See Decision Flowchart(over)(or qualifcations.Use separale MECH-SUM for simple 8 ccmplex systems.) <br /> E(]UI�1I170ttt SCIICCjU�tS The following information is required l0 6e inwrporaled wilh lhe mechanical equipmenl schr.du!es on the <br /> Iplans. For projecls without plans,fill in lhe required information below. <br /> Cooling Equipment Schedule <br /> Equip. Capacii� OSA CFM SEER <br /> ID 9rand Name' Model No� Blulh Total CFM or Ewno7 or EER �p�� LowGon <br /> Heatin E ui ment Schedule <br /> Equip. Capacit� OSA cfm <br /> ID Brand Name' Model No.' 81u1h Total CFM or Ewno? Input BWh Outpul Btuh EKcienc° <br /> Fan Equipment Schedule <br /> Equip. <br /> �� Brand Name' Model No� CFM gp' HP/BHP Flow Conlro� Loca6on of Service <br /> 'If available. �As lested according to Table 14-7A through 14-16. �If required. °COP,HSPF,Combustion E�ciency,or AFUE,as <br /> applirable. 'Flow control lypes:varia6le air volume(VAV),conslant volume(CV),or variable speed(VS). <br /> �s <br />