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9ate...__.`..__�� :_2j._,_l._.�._._. <br />..._....-.-�---�'u°°�-. <br />Applicatjortri�ermill...__..:.----._... . " . <br />.� Owner_�`_v <br />� r <br />Site P.ddress _� <br />Assessor's <br />� <br />, � Site Address <br />. <br />. <br />. <br />• <br />. <br />count <br />( ' <br />n `�� � � 0`i <br />WflISE_9ESIDENTIA <br />� <br />: <br />� ............................................................................................... <br />Owner's Address ............................................................................. C' <br />rry ...................... ............ Zip .................... Phone ............... <br />D�2y �� •(�� ...... <br />�.............. <br />Builder .....r.......�...�......., �.. ......�............... JT!U4C_7w> Address .............Pq.�...-�.�..:........Jj�;'x........ Z l.S�................................................ <br />City.........C...V..��/..`.'.`.-'../..� ..........................................................Zip....J...�..' .�� ....Phone...........�/..� — �� p <br />.. .. ...... ... .......... .�......7.L. <br />..-----......___ _.. � ......... <br />PRO�CT DESCRIP7ION: <br />o-r�W <br />O Remodei <br />FUEL SOURCE: <br />Q�dric <br />O Addition �/- <br />�nditioned Sq. Ft....��l....�..� <br />HEATING SYSTEM TYPE: <br />sebaard <br />; O Oil Wall hcater <br />• O 6as Q Furnace AFUE ................... <br />. <br />• <br />. <br />..................... <br />O�O;e Famity <br />O Mufti-Family <br />f of Stories .........:........... <br />Y of Units ......................... <br />O Heat pump HSPF .............................. <br />OOther ................................................. <br />O Total installed waps or BTU's ............ <br />• � � � � Y � � � Y 4 � t O � � � � � � � � � � 1 � � � Y • <br />Check one ol ihe Compliance Option Baxes below. Insert the values into box nu:nher 4. 6elore completir.p ihis <br />sectian refer fo fhe instmctlons on back of torm. <br />Electric - Horfhwest Energy Code, <br />Chap!er 6 <br />O Well Irsulated Floor O Systems Anaysis, <br />Option Chap1er 4 <br />O Well Insulated Wall C�•�ponent Pedormance, <br />Option Chapter S <br />O Passive Solar Option O Csmpener.t °oint System, <br />O Hcat Pump Oplion Chapter 7 <br />FOR DEPAHTMEHi USE ONLY: <br />Amount ot Payment 3 ....................................:.' <br />Date Perm1 lssued ....:...............::::......:....... <br />Date Permit Fnaled .....................::.................. <br />I herc6y certily ihal Ihis dwelling was buitt in �� <br />compiiance with �he IV19EC. <br />.................. _............................................ _........... <br />Buildinp Otticul or w�thonted Apenl � <br />Date <br />Olher Fuel Saurces - <br />Washinglon Stafe Enerqy Code <br />O Prescriptive Approacn, <br />Chapter 6 <br />O Compenent Pedormance <br />Approach, Chapter 4 <br />O System: Anaysis, <br />Chaptrr 5 <br />COMPONENi� <br />Flat Ceiling Rs�, <br />Vaulted Ceiling R........... <br />Wall R.7-.�. <br />Below Grade Wall: <br />in�erior R.,,..,,,,,,, <br />exteriar R............ <br />Floor q,7.s <br />Slab on Grade R.........r . <br />�oors & Frame U...,�.,f,l2z <br />GluinA U:3T..�� <br />%Glazin2 �-�.........% <br />SolarAllowance ,,,,,^/, <br />AirLeakage TD �pOV <br />.......... <br />� hereby certiry thal Ihe strucNrdl panels will meel tl�e NWEC Foimaldehyde reQuiremmts • eiiher Ne <br />HUD standards ormarked'exlennf or'exposurc 1' <br />Owner or Aulfiorized Agent: <br />..................................................................... <br />................................................................... <br />nnt ame SipnaNre <br />Theloraljunsdictlon/eleclrkutilirywillma..a paymentloeiNerthebuiWerorownerlornewelxlnwlly <br />h:atcd residenres. Permi� mus( be issued 6y 171'd;,9i and censiruc6on finaled hy N3pN2 in arder Io <br />qualily br p�ymenL To facili�ale payment_the lallowinp inlortnaGan must 6e filled out complelely. <br />�raileheekto:(pleasepnnq (qDUITIONS/REDif1DGLS NOT' GLIGI[3LG) <br />Name................................................ Fed. Taz ID or SSY...................................................... <br />Address................................................................................................................................. <br />Ciry. <br />Zip.. <br />� <br />