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x C" 'H�7 <br />[7 G� <br />9 �-3 <br />,O�x <br />'4 H <br />r x� <br />H � h�+ <br />O xo <br />'SJ H 's] <br />�n ri <br />h o� <br />H C7 <br />H C�'-] O <br />� V a <br />'�yz <br />HH <br />p�H <br />n�ti <br />r <br />[� <br />H O f�i� <br />Oate ____._�._� .oi �_./%_.------:.-, i-- <br />APPlication/Permit i1.__._�._-{�_�--_--'--.._..------- <br />Owner �_.__��i�f�L./.YJ_.-�-/---_.-��--'-�---�----...._ <br />Sltc Address C��.�.._..l��T ---�.�5/.�—'? ............. <br />Assessor's Pronertv Tax Account No. <br />. � Site Address <br />� � c� c� <br />Owner's Ad(d"r�ess ...{.�.....�................. .............................. .................. Ciry.................................... Zip .......... <br />Builder....L.�..C�l�?-`::1.:%..� ..............................Address.......�J.G4 7�:�,............................ <br />.• � <br />City ....................................................................................... <br />. <br />• <br />• � PqOJECT OESCI11PilON: - <br />; & �W dEitian <br />� O Remodel G CondNioned Sq. Fl..,........ <br />� FUELSOUHCE: HEATINCSYSTEMTYPE: <br />O Electric O 8asebwrd <br />; O Oil O�all heater <br />• O Gas O FurnaceAFUE ................... <br />ingle Famity <br />O MuHi-Family <br />: <br />Phone <br />� 0� $�Of105......./•............ <br />N of Uni�s ......................... <br />O Heat pump HSPF .............................. <br />OQther ................................................. <br />O Total installed watis or BTU's ............ <br />• <br />• <br />o .` <br />• � � � � � � � � � e e � � � � � � � � � � � � e � � � � � � � e � � � � � � � � � � � e � � � � � � • <br />Check one oi the Compiunce OD�on Bozes below. Insert Ne values inlo hoz num6er 4. Befare campletino this <br />section reler to the insWcGons an back of tarm. <br />� <br />� �� Electric - Horlhwest Energy Code, <br />`� e+ Chapler fi <br />O WeII Insulated Floar O Systems Analysis, <br />�Op'on Chapter4 <br />f�, � G'well Insulated Wall O Ccmponent Pedormance, <br />Option Chapter5 <br />O Passive Solar Option O C^mpener.t Point System, <br />O Heat pump Option Chapter 7 <br />� s <br />'4 4 ' <br />6 .,., '9 <br />FOfl OEPAFlTMEHT USE ONLY: <br />Amaunt ot Payment 5 ...................................... <br />Da�e Permit Issued ......................................... <br />Datc Permit Fnaled ......................................... <br />I hcrehy ccrtily ihat this dwclling vms built in <br />campiiance wrth ihe N'�4EC. <br />................................................................ _........... <br />Building Otikul or Aulhona^d Agen� <br />..........................................._.._................... <br />Date <br />Olher Fuel Sources - <br />Waahinpton Stale Enerqy Code <br />Q Prescriptrve Approach, <br />Chapler 6 <br />O Companent Performance <br />Approach,Chapter4 <br />O Systems Analysis, <br />Chapter 5 <br />COMPONEHT <br />Flat Ceiling R...�.�. <br />Vaulted Ceilinp R............ <br />Wall R..�..�.��!�� <br />Below Grade'Nall: <br />intcrior R............ <br />extcrior R............ <br />Flaor RE�!Ji.:�- <br />Slab on Grade R............ <br />Doors & Frame U............ <br />Gluing U..+..'.��. <br />%Gluing ....L�...% <br />SolarAllowance .........."/o <br />AirLeakane T� OADV <br />• <br />e � � � � � � � � • <br />I harehy certiry Nal �he slrucNtal Danels will meet Ne NWEC Farmaldehyde repuiremenls -ei�her Ne <br />HUD standards or marked'ezlennf ar'exposure 1' <br />Owner ar Autharized Aqent: <br />. . . ........................................................... ................................................................... <br />Pnnt Narne � Signamrc <br />Theloraliunsdiction/eleclricutiliywillmaNea paymenitoei�herthehuilderoravmerlorneweleelriw:y <br />heated residwces. Permit musl6e issued by 17/31A1 and cons�rucfian finaled 6y 6/30A2 fn oNer to <br />qualify �or paymenl. To lacilita�e Daymenl, the lollovnnp infortnatlon musl6e filled oul completely. <br />Mailehetk�a:(pleaseprinp (,�pUl'PfONS/RLi��IODGI.S NOT' I:l.?GI6LG) <br />Name................................................ fed. TaK ID or SSY...................................................... <br />Address......................................... <br />CM ................................................. <br />_.�._� � .. ,..v 6.�.���U�1� ' __ ._., ...�..1�' r+�� .e4e:.ar�.i3?e.. .�.,.,. ��y,_; <br />Zip.............. <br />NOiE: M Ifl5 Fcrtn 1 ff]'l nll �o :ent al :�e enC cl V.e yxar. <br />