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N�111 <br />�y <br />9 r3 CA <br />�< z <br />CA H <br />Soo <br />Wog <br />,r] V <br />AHI <br />t" H H <br />f� <br />H <br />n t7 fn <br />ttj <br />y O CA <br />C � <br />1 1s <br />1 <br />h' <br />!, i <br />Date -----— (--;--L----f -------- --, <br />APPIIcationlPermit 0 ----- ---------- ----- <br />Owner_ IC1 �Ce ------ "• LOWRISE RESIDENTIAL ;' <br />-_ _-p--- ----- -- <br />1`b. �!% COMPLIANCE APPLICATION <br />Site Address _ Z7 _.''� _ ------- <br />Assesso_r's_P_roperty_Tax Account No. OI{� LAkt <br />•PUD PLAN REVIEW NQ,O�I�U09g '' <br />L7 lc�2n1 /'`D..................................................... <br />• Site Address ......... ........................................................D............................................................................... <br />Owner's Address .....2- 7.............r...... Fk........ City ..... rV... Zip ..%.. Phone ................................... <br />® Builder_%�iloryLsf....�c.:N y....ndsaCuocS..Address...�/.-1.Z ....:3.J..�1....... ........tied(7 ............................................ <br />• .6V Zip .. ...........Phone..3jZ_/,—!s Z 337:1.�>" <br />Cry.............................................................. p................ ........................ <br />PROJECT DESCRIPTION: 2- <br />0 Now ,Addition pp Single Family I of Stories ..........:........... <br />O Remodel O Conditioned Sq. R.O Multi -Family I of Units ......................... <br />©} FUEL SOURCE: HEATING SYSTEM TYPE: <br />0 Electric O Baseboard O Heat pump HSPF .............................. <br />O Oil O Wall heater O Other ................................................. <br />• O Gas O( Furnace AFUE................... O Total installed watts or BTU's ............ <br />Check one of the Compliance Dpdon Boxes below. Insert The values into tax number 4. Before completing this <br />section refer to the instructions on back of form. <br />Electric - Northwest Energy Code, <br />Chapter 6 <br />O Well Insulated Floor O SysteefAnalysis, <br />OptioO Well Insulated Wall ohhmponent Performance, <br />Option Chapter 5 <br />O Passive Solar Option O Component Point System, <br />O Heat Pump Option <br />FOR DEPARTMENT USE ONLY: <br />Amount of PaymentE.......................... _......... <br />Date Permit Issued ... ................... ................ <br />Date Permit Finaled...................... _................. <br />I hereby certify that this dwelling was built in <br />compliance with the NWEC. <br />B...uild............._OHiw...l..or.....A.u..tll....e..d.....Agen.e'n.t.... <br />......._....... <br />.... <br />ing ..odz.... <br />................................................. _ ............ ........ <br />Dare <br />Other Fuel Sources - <br />Washington State Energy Code <br />O Prescriptive Approach, <br />Chapter <br />O Component Pedo mance <br />Approach,Chapte 4 <br />O Systems Analysis, <br />Chapter 5 <br />COMPONENT <br />Flat Ceiling <br />R...33 <br />Vaulted Ceiling <br />R........ <br />Ll... <br />Wall <br />R... <br />Below Grade Wall: <br />interior <br />R............ <br />exterior <br />R............ <br />Floor <br />R............ <br />lab on Grade <br />R....... <br />oors &FrameGlazing <br />rS <br />/..1......%olarAllowance <br />..........%ir <br />Leakage ®STD OADV <br />00*8000*0 <br />I hereby certiN that the structural panels will meet the NWEC Formaldehyde requirements -either the <br />HUD standu or marked 'exterior' of*exposure t' <br />owner or Authorized Agent: <br />ntNam�.G!PT77J/�.............. �n mre.. <br />...................... <br />Print Name <br />The lot Wrisdicton/electrie utility will mate a ayment t0 either the builder or owner for new electrically <br />heated residenus. Perrml must be;:I by 1 f91 and construction 6naled 6/30192 in order to <br />gleality for payment. To taeilnals payment, the following information_ must be hlbd out eompbley. <br />-Maff4ha <to:(pleaseprint) (ADDITIONS/REMODELS NOT ELIGIBL <br />Name .................................. fed. Tax ID <br />Address.............................................. <br />NOTE: An IRS Farm 1099 wit be sent 9 the Old of ew Year. <br />