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Activity/Pe <br />FORM INSTRUCTIONS: <br />Pleaia read before completlnp torm <br />� Fill In aN shaded IMormatbn boxea that apply to your proJect. �n..noi p�aca marke in the two left side <br />columne �abeled " COMPLIANCE RE�UIRED" and "INSPECTION APPROVED'. Since this form <br />will be evaluated tor completeness, you can avold unecessary permit delays by caretully providing all <br />required fMormation. You may disregard IMormatbn requestes that don't address your paA�ular <br />bufldirp or equipmeM. <br />t StaH members will help with general questions about filiing out this form. However, it (s your <br />reponslbility to provide specific information for heating systems, glazing, Insulation, and other <br />building specifications. For specHic requirements, refer to the Northwest Energy Code, 1987 Edition. <br />This form will ullimately be the basis tor all NWEC field Inspections. You can avoid probleme by <br />seekinp approval for any substitutions before incorporating them into the proJect. The building oii;clal <br />may require that you substantlate compllance claims about building products or techniques by <br />providing documentatlon �rom approved testing agencies or code authorities such as ICBO. <br />3 When your permit is issued, you will receive a copy ot this form. Boxes will be checked under <br />"COMPLIANCE REQUIRED" Indicating NWEC requlremeMs that must be incorporated into this <br />proJecl. Each checked requirement will be evaluated by the buildfng inspector and , when deemed <br />acceptable, marked approved in the "INSPECTION APPROVED" column. � <br />DA7E n �� -�� ciry �.,-y�.. ...,,.,,., -- <br />NAM° �'�A�%T�� ��as mt`�'Bu� DING ADDRESS LOT #_ <br />BUILDING,,,���,,,T(((YPE: COMPLIANCE PATH: <br />�New Residential: � Sirgle Fam. pcl��� ❑ Chapter 6(< 5000 Ft2) <br />Remodel Multi Fam. ❑ Component Pertormance Ch#5 <br />❑ Addltion # Stories_ (s 3) � Polnts System Ch#7 � 4 <br />Heating System Type: <br />EleCtrlC: <br />� Base board []Forced air tumace <br />OHeat pump yr�Zone heaters <br />potner <br />NWEC plan ravlew: (Department use or <br />Approved by Date <br />NOTE: All non•electrlcally heated <br />dwellinpa muat comply wlfh the <br />1986 Washlnyton State Ene�Oy <br />Cod� end other ordlnances o/ thls <br />lu�kdbtlon. <br />WEEB 11PRIL YO <br />Pepe 1 0( 7 <br />