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--�-I—`�l <br />oate---------- �----------- -- --- <br />� <br />APDlicationRermA / ---------------' ' <br />/ Owner �1�G�DN_�------------ <br />X SdeAddress�l7�b—/y-QC�u��—��• fv����' <br />�Assessor's Property Tax Account No. <br />Site Address ...1.�.�.10.......,l.Y�!I..�.�QX.L/.,(�GC7..... ��.c .............................................................. <br />Owner's Address .....SZl.IJ..G.....0:}.....O.D.�!(�� ..:................. Ciry..i!��'^...1..�..... Zip .................... <br />PpOJECTDESCHiPTION: <br />O New <br />O Remodel <br />FU�OURCE: <br />learic <br />dLition //O ./ <br />(} Condilioned SQ. Fl. J <br />................... <br />HfATINC SYSTEM TYPE: <br />Q Base6a:�d <br />; O o�t O w�n n��er • <br />�•� O Gas O Furrece AFUE ................... <br />• <br />• u�+t�mmavaa.—amavees. <br />• <br />• � � � � � � � � � � � � � � � � � � � � �7 � � � � � � � • <br />Phone................................... <br />Phone G./..f�.`.�.�%� ............................ <br />/ ol Stories.......' .:........... <br />/ ol Unils ......................... <br />O Heat Dump HSPF .............................. <br />Oaher ................................................. <br />O Total installed watls ar BTIJ's............ <br />Check one ol Ihe Complunre Opfion Bazes btlaw. Ireert Ihe wiues inlo bo: number /. Bclort completinp tl�is <br />seUion reler lo IAe InsifucOo�uoa bxk al lorm. <br />Eleelric - Northwesl Enetqy Lode, <br />Chapl�r 6 <br />Q Well Insulated Floor O Systems Analysis, <br />Option ,� C�hayter4 <br />O Well Insulated Wall tw[.omponen� PeAormance, <br />Oplion . Chapter 5 . <br />O Passive Salar Oplion O Compener.l ?oint System, <br />O Hrat Pump Option Chapter 7 <br />FOR�EPAHTMEHTUSEOHLY: r <br />Amoutrt ol Paymenl S .._`.:.: .....:: <br />Date Permitlssued . . .....:: ...::. ` <br />' Dale Permil Fnaled <br />�:r��: I hereby cerliF/ Ihat Ihii dwellinp vras buill in � <br />complunce wrth ihe NWEC. <br />:::.:... � : . -.�.....:_ � ......::. .....:... <br />��. BuiWmp Otlrcul or AutAomed ApeN . .. <br />�..::.: .......:. ._._..._�_ ..__.... <br />`�:D�te� � � �� . � . � <br />Olhet Fuel Sources - <br />W�:hinplon Sl�le Energy Code <br />Q PmscriptNe ApproacA, <br />Chaptcr 6 <br />O Component Pedormance <br />Appraach,Chap�erS <br />O Systems Anaysis, <br />Chapter 5 <br />inleriar R............ <br />ezterior R........ <br />Floor R.�.:S. <br />Slab on Grade R...�.../... <br />Doors L Frame U...7... O <br />Glazinp U.�.. .... <br />'hGlazinp 3.�....a <br />SolarAllowance� / ....!/. <br />AirLrakaqe d'STD OAUv <br />I hereby urtify tlul Ne slrucNry D+M� w^II meel ihe NWEC fortn�ldehyde rtQuitemenls • eiNer Ihe <br />HUDstuidudsornurked'exlerintor'a0�ute1: . � <br />Ownei or Aulf�orl:ed Aqenl: <br />. ................................................................. <br />.. .............................................................. Si n�wre <br />Pnnl Nane 0 <br />TTeloaljurisdictlon/eieclrku6lirywillmixe� p�ymentloeitl�erNebuikerorownerlarnewelxlrioly <br />he��ed residenus. Permit mus� be issued by tY31A1 �nd conslnxUon finokd Ey 6/JON2 in o�det �a <br />pwiily lot piYmenl. To luili�te D�Ymml, Ne lollaninp inlortn�uon must be filkd out canpklely_ _ <br />Mailcheck�o:(pk�seD��Q (ADDITIONS/RG�fODELS NOT [LIGIBLF.) <br />Name....... ...................................... Fed. Taz �D or SS/...................................................... <br />Zip.......................................... <br />xOTF'. A� IqS ioen 1093 w�n pe vnl ot oe enE cl �e �eL. <br />