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ynH <br />��� <br />y <br />C�H <br />� Hx C/� <br />HZH <br />FC f] <br />H �1 <br />�i1 H '+J <br />f/� H�+ <br />�OL+J <br />Hl7 <br />OH <br />'�1 C] t7 <br />N [�] O <br />fy] Y �% <br />�H� <br />gyy <br />or�u�i <br />��� <br />zy�n <br />HOcn <br />Activity/P� -mit # <br />FORM INSTRUCTIONS: ;,. _ , . <br />Please read be4ore completing form <br />��� <br />� Fill in all shaded Information boxes that apply to your project. R2noi place marks in ihe two left side <br />`. columns labeled " COMPLIANCE REQUIRED" and "INSPECTION APP90VED". Since this form <br />will be evaluated tor completaness, you can avo(d unecessary permit delays by carefully providing atl <br />required inlormation. You may disregard intormation requestes that don't address your particular <br />� building or equipment. <br />� z I, Staft members will help with general quoslions about lilling out ihis torm. However, it is your <br />�^�'� reponsibility to provide specific information for heating systems, glazing, insulation, and other <br />building specilications. For specitic requirements, reter to the Northwe�t Energy Code, 1987 Edition. <br />This form wili ultimately be the basis tor all NWEC field inspeclions. You can avoid problems by <br />seeking approval lor any subsiitutions betore (ncorporating them into the project. The building official <br />may require that you substantfate compliance claims about building products or techniques by <br />providing documentation irom approved testing agencies or code authorities such as ICBO. <br />■�i] <br />When your permit is fssued, you will receive a copy of tliis torm. Boxes wiil be checked under <br />"COMPLIANCE RE�UIRED" indicating NWEC requirements that musi be incorporaled into this <br />project. Each checked requirement will be evaluated by the buiiding inspector and , when deemed <br />acceptable, marked approved in lhe "INSPECTION APPROVED" column. __ <br />DATE-�-i�-r�: cuy r — ��u���y <br />y�/ 1 � f '� c , <br />NAME( / �G�'�� BUILDING ADDRESS 3 �� '- "'T' '" ` w � t LOT #_ <br />BUILDING TYPE: COMPLIANCE PATH: <br />❑ New Residantial: �'Single Fam. ❑ Chapter 6(< 5000 Ft2) <br />❑ Remodel ❑ Multi Fam. ($ Component Pertormance Ch#5 <br />�ldditlon ❑# Stories_ (s 3) C] Systems Anaiysis Chri 4 <br />� Po(nts System Ch#7 <br />Heating System Type: <br />Electric: <br />OBaseboard OForcedair(urnace <br />�Heat pump ,�].Zone heaters <br />0 Other <br />NWEC plan revlew: <br />Approved by <br />use or <br />Date <br />NOTE: Au non•electrlcally heated " s <br />dwellings musf comply wlth the <br />1986 Washington State Energy <br />Code end other ordlnances ol thls <br />Juriadict(on. <br />.�r � ,� • ; ; <br />WEEB APflIL VO <br />� Page 1 of 7 <br />� <br />� <br />