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H C7 �-+ <br />�9H <br />,ozx <br />aHtn <br />K�n <br />Ox0 <br />� Cn H <br />z <br />Eii o t33-- <br />�a <br />H L�7 O <br />(,] V �] <br />9H� <br />CHy <br />� <br />H <br />n�� <br />r <br />z H c�n <br />i-3 O ti <br />oate .....Ll._ __2_0._- c! 1 ...................._ ........_.._._. _._......... <br />Application/Permit / ------.-.--.._._...__......_._�..7..._...._ .1._. <br />Owncr �J ��v..%'._'%h`.'__��!S�N _�-.�........_..r.�...�........_ <br />SiteAddress --------��------�--------._.._._...--�----�-� <br />Assessor's PropertY. Tax_Account_No: <br />•oiin ��eU ��Fvrrw Nn Ao—�//" O/ iS�J <br />• <br />• <br />• <br />: <br />• <br />OWNISE hc510EN <br />. <br />� • a <br />SitcAddress .��.�........�i/�+�/�S.t�J ................................................................................................................................................ <br />Owner'sAddress.�o:.��".`.7�- ��.v2.G..�¢. rty..Wk.!'E.'L.�d..........Zip _�a�3..Phone.��..�.�..:' y.%.�S <br />.....� ............................ C� . ,� ..... ..... <br />Builder�IA�(7.�-.�._�!D.�..�I.9.f.'?.K>....l...Y....�............ Address.��.�.f.:2Q�'X�:.... zZ(q,..�.P .......................................................................... <br />City...�..�F.r .f.E��� ................................................................ Zip ....1..�.. �. 3......... Phone ...� �..�.`�. ..-..�:..7.�..�-�..�......................... <br />PROJECT OESCRIPTION: <br />New <br />Remodel <br />FUEL SOUflCE: <br />�Electric <br />O Oil <br />O AdEition �/ <br />G Conditioned Sq. FLP��....�..J'.`�....L.. <br />HEATING SYSTEM TYPE: <br />O Basehaard <br />� �Vlall heater <br />. Q Gas Fura�ce AFUE ................... <br />O S ngle Famxy / ol Stories.....�.�...._•........... <br />O Mufli-Family Y of Units ......................... <br />O Heat pump HSPF .............................. <br />OOther ................................................. <br />O Total installed watts ar BTU's............ <br />• <br />. _�_,__----��T ::,_ �_..�....-����-�.�-,�-�,;,a�:�� <br />. <br />• � � � � � � � � � � � � � � � � � � � � ���� � � � � � e � � � � � � � � � � � � � � e � � � � � � � � • <br />Check one of Ne Cimpliance Oplion Boxes betow.lnsert Lhe va!ues inio 6oz numher;. &lore compielinp ihis <br />seqion reler Io lht insirucoons cn 6ack oi;e�m. <br />Eleclric - Hadhwesl Energy Code, <br />Chapter 6 <br />Q Well Insulated F!aor �Systems Anaysis, <br />Optian Chapter 4 <br />Q Well Insulated PJall O Componmt Pedormance, <br />Option Chapter 5 <br />O Passive Solar Oplion O Cempc�cr.I °oint System, <br />O Hcat Pump Option Chapter 7 <br />FOR DEPAflT�dEHT USE � iNLY: <br />Amount ol Payment 5 ............. <br />Date Pcrm4 Issucd <br />Dalc PcrmA Fnaled <br />I hereby certity that this dwclling vns buiA in <br />compluncc wnh thc NWEC. <br />.................._............................................_........... I <br />Buildinp Otikul orFuthonted Apeni <br />Dal� <br />Olhar Fual Saurces - <br />Washin9tan Slalo Enerqy Coda <br />Q Presctiptrve Approach, <br />Chaptcr 6 <br />Q CompcnenlPedarmanee <br />Approach, Chaptcr 4 <br />Q Systems Anaysis, <br />Cha��er 5 <br />� COMPONENT- <br />' Flat Cciling <br />� Vaulted Ceiling <br />i Wall <br />Below Grade Wall: <br />interiar <br />� exteriar <br />Flaar <br />Slab on Grade <br />Doars L Frame <br />Gluinp <br />°/ GlazinV <br />Solar Allowance <br />Air Leakage � <br />..•....... <br />F�. a <br />I herc6y ccrtily Ihal Nc s�rucNral panek vrill meei U�e NWEL farmaldchydc rcpuirements - eilhu Ihe <br />HUD sla�dards or marked'exlcunf or'expr.um 1' . <br />Owner or Authorizod Aqenl: , % <br />- - ` � '- . � �ld1l/ <br />� / )'t e <`-" h J � %< � <br />. ...........r.......l�C ......................... �I,�.��C.(..�..�.....'.........�............ <br />Pn�t Nune <br />•� The lool jmisdicuoNelttltic utiliry will make � paymept lo eitiier Ne buiider or owner lor newelecluralty <br />hwled iesidenres. Permi� must be issued 6y 11/71NI arid eons�ruclion finaled b�/ 6�3�N2 in oNer lo <br />Qwlify lor paymenl. To lacililale poymenl_Ihe lollowinp inlormalion must be filled aul comple�ely_ _ <br />�dailchetklo:(plcaseP�inQ (qUU]'1'IOhS/Iilit401)GI.S XO'I' IiLIGIf1Lli)- <br />- ' " �'' ' <br />Namc/Ylr.. �'....(i'�/.��.�........ Fed. Ta�c ID or SSY.✓..s..:1 �._Cci.C..:-..<'l.f�.�'..... <br />Addres�s f...'..�:...��' X...:�r.�l:..li.' ..................._.............................................................. <br />Ciry...S. :4�F'.L:!:..�:?`��...�:��lls�f........." .................. Zip........��.i?C'.75............. <br />NOII: M IPS Fon 1 P7S Mtl De unl at L1e en0 N Ox Jear. <br />