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J � <br /> i � � � .COIAPONENT <br /> ��1' FlatCeilinp R'3� • <br /> I � Check one of'�e Compfuna OOtion Boxes below.Insert the vilues inm 6ox num6er 4.Belore comD�elinp Ihis Vaulled Ceiling A......�.y... <br /> I ' - - seUion rder to the fnslmcnons an bock oi fortn. Wall R..i.L.... <br /> Below Grade Wall: <br /> �( ._� Eledric•Nodhwest Enerqy Code, Other Fuel Sourcas- interior R............ ' <br /> ` Chapier 6 - Washinylon Slale Enerpy Code <br /> � extcrio� R............ <br /> p Well Insulated Floor O Systems Anaysis, O P�escriplNe Approach, floor R.2..� <br /> ��, � Option Cha ter4 Chapte� 6 <br /> O Well Insuiated Wall omponent Pedormance, O Component Pedormance SIa6 on Grade R...,�� <br /> ,� Opiian Chap�er 5 Approach,Chapier 4 Doors 6 Frame LLc......... <br /> �� �� O Passive Solar Option O Cempe!�er.t Point System, O Systems Analysis, Glazinp U..+.�].�.� <br /> Chapter 7 Chaptcr 5 '�Glazinq l..l...'/e <br /> O Heat Pump Oplion SolarAllowance ..........!/o <br /> AirLeakage �� OADV <br /> � . <br /> �� <br /> o . . . . . . . . . . <br /> _ <br /> �'�• <br /> . � FOROEPARTMEHTUSEONLY: � ' � ' ' � r' � � � <br /> _ Amoum ol Paymenl 3...................................... I hereby cerliry Nal lhe slrucNr�l pinels will meel tlx N\YFC Fortnaldehyde reQuiiements•eiNer Ihe <br /> - � HUDslmdudsornuhed'extenotor'exposurel' . <br /> � � Owoer or Aol6od:ed Apenl: <br /> Date Permit Issucd...:..................................... <br /> .................................................................. <br /> .................................................................... . <br /> � � �� PnntNvne Sipn�mm <br /> - Da�ePe�mdF�,ialed......................................... Theloc�Ijurisdkuonhianku6lirywiiim�Kea y+ymenitodUerNe6uilderorowner�ornewelxtricalty <br /> � � � � � ht�ted iesidences.Permit musl be�ssued 6y 17/31H1�nd construcUon fimled�q NJ�92 in oNer to <br /> � qwlity�or p�YmenL To I�ciliBle prymml,tl�e lollowinp inlortn�tion mus�be filled out comDktely_ _ <br /> Iherebycertirythatihisdwcllinpwasbuihin 'Mailcheckla:(plenepriN) (ADDITIONS/RL•�fODHLS NOT [LIGIBLE) <br /> compliance w�h�hc NWEC. <br /> Namc................................................Fed.Taz ID or SS/...................................................... <br /> .................._..................................:........._........... � <br /> Buildinp Otlicul or FuNori7ed Aperil Addre55................................................................................................................................. <br /> ..............................:....................—._......_.....:... Ciry........................................................................................ Zip........ ............................... <br /> : � D�te � � � . <br /> NotF:M INs iaim 1099..n ne unt�i n<ena o�cu�ea�. �. <br />