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n <br />4 <br />. .. �. c.' ". <br />��� �A� ;. j � <br />• • <br />��� 2320 Califomia St., Everett, Washington 9f3201 258-8?? 1 <br />'� ' Mailing Address: F. O. 8ox 1107, Everett, INashington 982C6 <br />� <br />�nohemish FUD RePerenc��O�NLYJI'�� <br />Lnergy Plan �vi.ew e; :'. <br />��NWEC" flan Review anfl Compliance fcr :3lectric Hea,t �esidences <br />D3te: ���3 � / <br />Plan �'�eck No: <br />Assessor's Property Ta.x Accoun:. No: <br />Jurisdict:_on Basic Plan tt: <br />sui.lder: (�C Itl �, �L��A�• ---- <br />Address:� i�i� J''��'z��l ��l',- ���=,"_ <br />��ty: � . . R ►��c, r,�� (fi��rrTa� <br />Phone: "7�[?,n? I � - <br />Sinale Family:�_��x� <br />i�iulti-Family: _ Buildings:_ Units:__ <br />Site Address: �_ , ` ` <br />Compliance: Chapter 4-Systems Analysis_, Chapter 5-Com�onent Performance_ <br />Chapter 6-Prescriptive_, Chapter 7-Component Poi�it <br />Note: See attached documentation for ener.gy requirements• <br />Snonomish County PUD nl Representative: Sig��ture <br />Pr:int Phone <br />*ITEMS BELOW ARE TO BE FILLED OUT_BY THE APPLICANT*_____________ <br />Suilder / Coiisumer Payment <br />�'C, J �1:�'v�l <br />Owner or Authcrized Agent:� S gnatux-e Print <br />Amcunt $ <br />Idail Ch2ck To: <br />Name:C�-� %� ��� <br />Address: �- <br />City, St.: � � <br />Taa Id.n or SS�:��, <br />Note: An IRS Form 1 <br />NOR� <br />ENERGY CODE <br />hp sent at the e <br />of the year <br />�� <br />�J� <br />:,.a�..v, S�e; : c,�<:.:. mvv.�- <br />�;: <br />� <br />