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Phrne. ._..,.: '.:...:.�.�. <br /> H7� � Builder.........................................................................Address......................................................................................................................... <br /> � H'�TJ • <br /> City.................................................................................................Zip....................................Phone................................................................ <br /> (p 1-i . <br /> y Cg . <br /> � O t�! � <br /> Hl7 • <br /> O H • <br /> '.�V �g � <br /> y�„ n • PpOJECT OESCflIPTION: <br /> � O New O Addition O Sinple Famih/ f of Stories.....�..:........... <br /> Y H� O Remodei C'�Cond'Aioned Sp.FI..................... O MuNi-Famih/ d of Units........................ <br /> t� r-i H � FUEL SOI1pCE: NEATING SYSTEM TYFE: � <br /> gy H � Eleclric • Baseboard O Ileal pumP HSPF .............................. <br /> c'� lq7[n • O OiI O Wall heater O Other................................................. <br /> � C+�� . Q Gas O Pornace AFUE.................. O To�al installed watts or BTU's............ <br /> Z H p� � <br /> H O Cn ' <br /> . <br /> . . • • � . • • • • • � � • • � � • � . �• • v • � • • • • • • • • . � • • • � • � . • • • . � • • • • • • ,� <br /> COMPON:NT <br /> �i i • i• � �. <br /> flat Ceilinp R...^..`.:::... <br /> Check one ot U�e Complunce Optlon Boxes below.InseR Ne v�lues inta hox nu�nbet 4.Belom completinp Ihis Vaulted Ceiling R.:�::�... <br /> seGion rzferto lhe instrucboraoa back af�oim. Wtll A�mJ•r�•••� <br /> ��.� Eleclrio•Norlhwest Enem7 Code, Olher Fuel Source:- BelowGrade Wall: <br /> Chapter 6 W�shinqton Stala Enerqr Gode interior R............ <br /> e�erior R............ <br /> �Well Insulated Floor O Systems AnaNsis, O P�escriptive Approach. Floor R�••� <br /> 0'�'w Option Chapter 4 ChaDtcr 6 <br /> �� Q Well Insulated Wall QSCompanent Pedarmance, O Com�or=nt Pciformance Slab on G�ade R............ <br /> Option Chapter 5 Approach.Chapter 4 �oars 8 Frame U.:...'�.�... <br /> OPas:NeSalarOption OCempener.t?oi�tSystem, OSystemsAnaysis, Glazing U.'�.� <br /> Chapter7 Chapter5 /oGluinp ..,..••••.•% <br /> �„� O Heat Pump Option SolarAllowance ..........% <br /> Ai�Leakage �STD O A�V <br /> • <br /> � . � � . � . � . a . <br /> .�� <br /> ��"� FOfl OEPARTMEHT I1SE ONLY: � ' � ' � ' � � � � <br /> C� AmouM ot Payment 5...................................... I hare6y ceniy ihat the stiuctual Danels vrill meel ihe NWEC Fortnaldehyda reQuirements•eiNer ths <br /> HUD slandaids armarked'ezterinf or'exposure 11 <br /> Date Permit Issued......................................... <br /> Owner or Authorfzed Aper.:: <br /> �w .................................................................. <br /> ..................................................................... SiOnxWrc <br /> FrinlName <br /> 9ale Permit finaled......................................... The loal�urisdic6onlelecltic utiliry yri11 maRe a Vaymenl lo either Ue 6�ilder or awner�or newelectrifaly <br /> heateA resiaences.Pertnit must be rssued 6y 17/31A1 aM constnu6on finaleA by f�30N2 in order lo <br /> awliry lor WYment.To lacilitale paymenl,ihe lollowinp inlarmafion must he(Iled out completely_ _ <br /> � Ihere6ycenifythatthisdwellinpwasbui9in -Maileheekto:(pinsepiiN� �;ppITIONS/RGp10DL1,S NOT GLIGI[1LE) <br /> campliance wrth the NWEC. <br /> ............................................................................ <br /> Name................................................Fed.Taz ID ar SSY...................................................... <br /> BuildlnpOflkialorAuthoritedAgent Addfess................................................................................................................................. <br /> ............................................_.._._. <br /> .................. 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