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��� <br />H <br />�Hy <br />y�H <br />�H� <br />y y '� <br />xx <br />C�1y� <br />H�g <br />�V n <br />Cy� <br />Hy <br />S�' <br />H <br />C7 l7 (A <br />�HN <br />HO[n <br />Da�a........�,...�--`-�-----, - �-� ----'-'- ��� �/ <f //.' ,/� <br />,. " ' � <br />Application/Pcrmit � -_-_-_--------_----- .-- _- � <br />� <br />owner-------_._......--------------_.—_-----...__ , ''••. <br />. <br />s�ianadr�s5..s7"2-f�iGilutr!� _ RO.-----C�t/3 �.� �c� � � <br />Assessor's Property_Tax Account No. / <br />• .. � �r� r� <br />. Si�e Address ..... �.��..�......7.��.. r .................! c .� <br />ir..} ................ <br />• <br />. <br />. <br />. <br />. <br />Own¢r's Add�ess .....!:..."... �.'.�:.: :.."` .......................................... Ciry <br />Builder�..�.�.....Ca"tv..5 ..........................Address a:.:�.� <br />...... <br />�Ih'.....� i V; e`r:�.-.:.I.4 ............................................................. ZIP.. <br />PflOJECT OESCpIPTION: <br />O New <br />O Remodel <br />FUEL SOUpCE: <br />Q Electrie <br />�'AdEitian c� <br />G Conditioned Sq. Ft..:3../...�.. <br />HEATING SYSTEM TYPE: <br />Q Baschoud <br />� O Oil O W�II hcater <br />• O Gas � FurnaceAfUE ................... <br />i �� <br />m Sinqlc famiy <br />O Mufli-Famiy <br />�� ._-; / _A <br />_.r.�,.,_ <br />/ ot Storics......� .:........... <br />/ ot Units ......................... <br />O Heat pump HSPF .............................. <br />OOther ............................................... <br />O Total Installed wans or BTU's. �:�'U <br />. <br />• . . . . ...._ . . . . . <br />. <br />•���������e�����������������������������������������• <br />Check one ol Ihe Compliance Option Boxes below. Insert Ne values inlo taz number 4. &loie camplelinp Ihis <br />seUion reler to Ihe insliucdanson back af larm. <br />Eleolric - Nohhwesl Enerqy Cade, <br />Ch�pler 6 <br />Q Well insulat¢d Floor O S stoms An�ysis, <br />Option C apler 4 <br />O Wcll Insuiated Wall Component Perfarmance, <br />Option Chapter 5 <br />O Passive Salar Oplion O C:mpener.t?oint System, <br />O Hrat Pump Optian Chapter 7 <br />FOfl DEPAfiTMENT USE ONIY: <br />AmouM oi Payment E ...................................... <br />Date Permit Issued <br />Dale Permit Finaled <br />I hereby certify that this dwellinp was built in <br />campliance wnh the NWEC, <br />............................................................................. <br />Duildinp Oflkul or fwtliodied ApeM . <br />Date <br />Olher Fuel Source� - <br />W��hinplan Stala Enerqy Code <br />Q Pr¢scriptive Approach, <br />Chapter 6 <br />O Component Pedormance <br />Approach,Chapier4 <br />O Systems Anaysis, <br />Chapter 5 <br />COMPONENT <br />Flal Ceiiinp <br />Vaulled Ceilinp <br />Wall <br />Beiaw Grade Wall: <br />Interior <br />exteriar <br />H............ <br />R............ <br />Floor R.zS <br />Slab an Grada R............ <br />Doors d Frame U.......—. <br />Gluinp U.:`f�� <br />%Gluinq Z3„e� <br />SolarAllowance .......°k <br />AirLaikago • STD OA�V <br />...•.•.•• <br />1 here6y urtily Nal Ihe sltucNrai paneLs will mcet tl�e NWEC Farmaldehyde requ' enls • either tl�e <br />HUD slandards ormarked'ezteriuf or'exposum 17 <br />Owner or AyIhorl:ed Aqenl: � G <br />�li.� l�bl��i..s ��o • <br />..................................................................... .. ...... ... �.. .. .:... ..... .................... <br />Piinl Name SIOnaWre <br />lhe Iocil jwisdic6oNelechic ufiliry will mape a payment lo eitherMe 6uiider ar ovmer lar naw eleclriwlty <br />hwlal iesidences. Permil musl be issued by 1?/71Nt aM eonslruc�on Analed bp 6/30A2 in oMer to <br />qualiy lar paymenl. To I�cililala p�ymenl, tl�e �allowinp inlortnatlon musl he filled oul complelely. <br />Ma(Icheckto:(pleaseprinl) rpUDl'1'IONS/RGt•IODCLS NO'P GLICi6LG) <br />Name................................................ Fed. Tax ID or SSt...................................................... <br />Address................................................................................................................................. <br />Zi p .......................................... <br />NDtF: M IFlS Fartn 1099 vnn W unt al IAe end W IAe year. <br />