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O <br /> Date ......,_3._= __�_ _.____---..__.. : �__....... . Q � � L:� LI U tS , � �.; <br /> • �/ i �a �'��� <br /> Applic:ticn/Pe iti.._...Lr6..���..._._.�---...._._ :. .. ;;.� <br /> , � � •, LO'NHISE NESIDENTIAL ,' <br /> ownei......_._..__...,�.._..._._..... _�.._._._....�.........� �QR 7 �991 , . <br /> � . � � • � <br /> Si!:n�ia�ess__-�.-._3.�_1._._/�+^�`tr�o........I�':..._...� ff+J LJ�KE <br /> �............................... ....,,,,�.m. <br /> _��Y �QF ��ER�T'{' .'.' n <br /> ::. V J <br /> 0 <br /> Assessor° s Pro ert Tax Account No. "" .; <br /> . .. <br /> ;_.. <br /> ..._.. ...-�--�--- ---.......P.._..__Y......._........_..................._..._........__. ��PT!1 Wfl� '�.�. ;. <br /> . ..... . .. ..::�. <br /> _ . ... . :��i <br /> 'PUC PLAN RGVIENJ N0. U G/'� �U3 " "�` <br /> . yx�; r, �ur'��.. <br /> ... <br /> � Sile Address ......�:.3.2 l ��OLJ�{-✓LD..............��:............... ..............LV....�.�....�'.....�.................................................... <br /> � ............ .................... <br /> Owner's Address............................................................................Ciry....................................Zip....................Phone................................... <br /> � �P-�A� �fi✓ CC`�5't/�c�`Address......................................................................................................................... <br /> Builder... ................................................................... <br /> 33�-.7.(5..�.................... <br /> ' Ciry.................................................................................................Zip....................................Phone.......................... <br /> • <br /> � . <br /> . <br /> . .,:�;w�.�� - <br /> • PRO�ECT DESCNIPTION: <br /> ° <fylVew O Addition l �, O Single Family n,� �(�7( N of Stories..........:........... <br /> � p Remodel G Conditioned Sq.Ft..........t.�� O MuRi-Famity f Y of Units......................... <br /> � F�UE./LSOUHCE: HEATIHGSYSTEMTYPE: � <br /> cy-tiectric O �sehoard O Heat pump HSPF .............................. <br /> � O Oil C9�h'all heater OOlher................................................. <br /> Q Gas O Furnace AFUE................... O Total installed waris or BTU's....�6��`� <br /> . �� <br /> e <br /> • . <br /> • <br /> • � � � � O � � ! � O � � � � � O Y � � • � • � � � � � � � � � � � � � � � � � � � � � � � � � � � � • � <br /> � COMPONENT 3 � <br /> • " ' • '` '• ' Flat Ceiling R............ <br /> Check one of the Compliance Option Bozes below.Insert Ihe values inta boz nurtiber 4.Before compleling lhis Vaulted Ceiling R........... <br /> sectian reter�o ihe instructionsun back ollorm. � Wall R..y�. <br /> Below Grade Wall: <br /> Electrie-Northwest Energy Code, Other Fuol Sourcas- ' interior R............ <br /> Chapter 6 Washinqlan Stale Enerq�Cade QMerior R............ <br /> Q Well Insulated Floor O Systems Anatysis, O Prescriptive Approach, Floor R••.�S• <br /> Option Ch pter 4 Chapter 6 <br /> Slab on Grade R........... <br /> Q Well Insulateu Wall omponent Pertormance, O Component Performance Doors&Frame U..r.�� <br /> Option Chapter 5 Approach,Chapter4 <br /> Glazing U..R3.?.'�� <br /> p Passive Saiar Option O C^mpene^t Point System, O�Ystems Pnatysis, </oGluing �.Y......% <br /> OHeatPumpOpticn Chapter7 Chapter5 SolarAllowance <br /> ..........'k <br /> AirLeakage C✓S`TD OAD!i <br /> • <br /> v • � � � � � � � � s <br /> FOR UEPAiiTMENT USE ONLY: I f�' t °�' � ' � ' � � � � <br /> �,i�v <br /> AmountotPayment5...................................... �, .'. Ilv:n:L,�ziiitythal�heslmcNralpanelswillmeellheNWECFoimaldehydereQuiremenis•eilherNe <br /> �; ��' HUD slmdards or ma�ked'exterior or'exposure 1' <br /> . .. ... ... ... � ;� OwnerorAuthodzedAqent: .UJ C 1 , ��LK;;^�'���1/j <br /> Date Permit Issued................. � « _ �......:'� c.l N:..:....�:�......... ..:.. ....i�.............. . <br /> r��::.�.-..r....na_.w:...... .. �' ..� L . <br /> .�..... .. Si naNre � . <br /> p PdnlName A <br /> Date Permit Fina�ed......................................... � Th¢1af21 j11115dit6on/eleClfh;ufiflly Wili maNe a payment la either�he huilder or ovmer tor new electrically <br /> . heated resid�nces.Permit mun he iss�ed by 12/3751 and canslrucfion finaled 6y 6l30A2 in aNe�ro <br /> . qualiy lor paYmen[.To facililate Daymen�,tl�e following inlarma6on musl6e fitled aul cort�pletely_ _ <br /> " -- - - - - - — - -- - - - -- - - - - - - <br /> Ihere6yr.ertifythatihisdwellingwashuillin Mailtheckto:(pleaseprinq (ADDITIONS/RGDIODGLS NOT ELIGI6LE) <br /> campliance wdh ihe NK EC. C'U u <br /> � Nam�����...lu�..�:.......:....��d.Tax ID ar SSi...................................................... <br /> ............................................................................ / � <br /> Buildin0011iculorAuthonzedA��nt Addfess..�..�.Zr�..-.�.[.�.�.�.:�.s...s�..'................................................................. <br /> � n <br /> City L (/L�.1= L (��. �✓ �- . .......... Zip... ...�.z.�:..�........... <br /> .... ................. . <br /> ................._........,............. .... <br /> Dale Y .,... ......,. ,W.��:�,:��r> <br /> �..���.�.�..�,..��..�..,,..���..�.,,,�.���� NOiE:MIRSFomi1047vnllbesentatlf,eendofNaycar. <br /> i <br />