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��� <br />H <br />�H� <br />��� <br />H �J <br />� H � <br />Hy <br />z <br />o�d <br />��g <br />�Y � <br />t"y� <br />HH <br />gy <br />C] t1 fA <br />�HVi <br />HOCn <br />� <br />FORM INSTRUCTIONS: <br />Activity/Pr LL .nit # <br />Please read batore completinp form <br />Z� <br />Fill in all ehaded Informatbn boxes that apply to your proled. �n.nOt place marks In the two lett side <br />columns labeled " COMPLIANCE REQUIRED" and "INSPECTION APPROVED'. Since this form <br />will be evaluated tor completeness, you can avold unecessary permR delays by carefully providinp all <br />required Inlormation. You may disregard IMormatbn requestes that don't address your particular <br />building n� equipmeM. <br />StaH members will help with general questions about tilling out this (orm. However, tt is your <br />reponslbilfty to provide speciflc IMortnatlon for heatinp systems, glazing, insulatlon, and other <br />building specificalio�s. For specHic requirements, refer to the Northwest Enerpy Code, 1987 Edition. <br />This form will uftimately be the basis for all NWEC fiald InspecUons. You can avofd problems by <br />eeeking approval for any subetftutions before incorporating them into lhe project. The building oNicial <br />may require that you substarnlate compliance claims about building products or techniques by <br />providing documentation from approved testing agencies or code authorities such as ICBO. <br />When your permK is issued, you will receive a copy of this form. Boxes will be checked under <br />"COMPLIANCE AE�UIRED^ Indicating NWEC requiremenis that must be incorporated into ihis <br />project. Each checked requirement wlll be evaluated by the building inspector and , when deemed <br />acceptable, marked approved in the "INSPECTION APPROVED" column. <br />�To 7 <br />�lQ,y�,y�I� �1 <br />DATE�'/J--/�CI1y GV�.."'��� GOU01�/ .�ivv�rui-�i.:�ro <br />NAME I�Sir}O �on15�h" UILDING ADDRESS LOT #_ <br />BUILDINO TYPE: COMPLIANCE PATH: <br />� New Residential: ❑ Single Fam. ❑ Chapter 6(< 5000 Ft2) <br />❑ Remodel �� Muflf Fam. �%�+!'�Q"X �Component Pedormance Ch#5 <br />� AddNion �[] # Stories_ (s 3) Systems Analysis Ch# 4 <br />� Points System Ch#7 <br />Heating System Type: <br />Elecir(c: <br />0 Base board 0 Forced airfurnace <br />�Heat pump �Zone heaters <br />0 Other <br />NWEC p/an revlew: (oepanment use oniy) <br />App►oved by Date <br />NOTE: All non•electrlcally heated <br />dwelfinga muat comply wlth the <br />1986 WaBhlnpton State Enerpy <br />Code and other ordlnances ol thls <br />Jurlsd�cUon. <br />WEEe APpIL YG <br />Page 1 ot 7 <br />