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dS-OI�`'"�� <br />Activi#�a�/Perrr�'`; � <br />_ ;� �. . . . , , . . . : • . � � r'i:� <br />+ <br />` . � - • v�� _; >: �:. � : : . " - ... _....._.���, ��..� � �..:�.��a � x �. . �:.;: <br />3 <br />DATE <br />FIII in all shaded InSormation boxes that apply to your project. �n.nQt place marks in the two left side <br />columns labeled " COMPLIANCE RE�UIRED" and "INSPECTION APPROVED". Since this form <br />will be evaluated for completeness, you can avoid unecessary permit delays by caretully providing all <br />required information. You may disregard Information requestes that don't address your perticular <br />ouilding or equfpment. <br />Staft mernbers K�ill help with generai questions about tilifng out this form. However, it is your <br />reponsibiliiy to provido specific iniormalfon for heating systams, glazing, insulat�Code 1987 Edition. <br />building specifications. For spectlic requirements, sofer to the Northwest Energ� <br />This form will ultimately be the basis for all NWEC tield inspections. You can avoid probloms by <br />seeking approval tor any substitutions before incorporating them into the project. The build(ng otticial <br />may require that you substantiate complia�ce claims about building products or technfques by <br />providing documentation irom approved testing agencies or code authorities such as ICBO. <br />When your permit is issued, you will recbiae a copy of this form. Boxes wiil be checked under <br />"COMPLIANCE RE�UIRED" Indicating NWEC requiremenis that must be incorporated into this <br />project. Each checked requirement will be evaluated by the building in�pector and , when deemed <br />acceptable, marke� approved in the "INSPECTION APPROVED" column. <br />unty <br />NAME�I.MC� '�{-Eu�Y BUILDING ADDRESS S�S M/}t��5a�1 ST LOT # <br />BUILDING TYPE: COMPLIANCE PATH: <br />�New Residential: ❑ Single Fam. D�iDJea( 0 Chapter 6(< 5000 Ft2) <br />Remodel �( Multi Fam. � �Component Perlormance Ch#5 <br />� Addliion ❑# Stories Z(s 3) Systems Analysis Ch# 4 <br />� Points System Ch#7 <br />Heatir�g System Type: <br />Electric: <br />Cj Base board <br />OHeat pump <br />� Other� <br />�Forced air furnace <br />Zone heaters <br />NWEC �Slan revlew: <br />Ap�roved by <br />NOTE: All non-electrically heated <br />dwellings must comply wlfh tho <br />1986 Washington State Enerpy <br />Code and other ordlnances of thls <br />Juriadictlon. <br />���.a : <br />WEEB �PpILYO <br />USe only) <br />DBte page �I ot 7 <br />;;,:„ :. <br />