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yn� <br />c r � <br />� � � <br />b <br />C M <br />� H N <br />K � n <br />H %7 <br />O C O <br />ro.+�a <br />y ,+ <br />`��Ei <br />O M <br />��R <br />.n+ � c <br />Zy N i <br />t� y 2 <br />N r3 <br />N <br />O N <br />�t�p � r <br />2Ht�n <br />H O w <br />� � <br />D�— Q! 43 Activity/P, rmit # <br />FORM INSTRUCTIONS: <br />2 <br />3 <br />Please read before completing form <br />Fill in all shaded intormation boxes thal apply to your project. Dnrmol place marks in ihe two left side <br />columns labeled " COMPLIANCE P'QUIRED" and "I�SPECTION APPROVED". Since this lorm <br />will be evaluated lor completeness, you can avoid unecessary permit delays by caretully providing all <br />required iniormation. You may disregard inlormation requestes that don't address your particular <br />building or equipment. <br />� Staff inembers will help with general questions about tiliing out this form. However, it is your <br />u reponsibility to provide specilic intormation for heating systems, glazing, insulation, and other <br />buiiding specilications. For specific requirements, refer to the Norihwcst Energy Code, 1987 Edition. <br />This torm will ultimately be the basis lor all NWEC fieid inspections. You can avoid problems by <br />seeking approval br any substitutions belore inco:porating ihem into the projeci. The building olficial <br />' may requiro that you substantiate compliance claims about building producis or techniques by <br />providing documentation trom approved testing agencies or code authorities such as ICBO. <br />When your permit is issued, you will receive a copy of ihis torm. Boxes wiil be ch�cked under <br />"COMPLIANCE RE�UIRED" indicating NWEC requirements ihat must be incorporafed imo this <br />project. Each checked requirement will be evaluated by ihe building inspector and , when deemed <br />acceptable, marked app:oved in ihe "INSPECTION APPRCVED' column. <br />EXC3Ti.�CT �oWWt /`�us <br />2-� <br />DATE -�f `� Clty �V��T� County S�JoltDh rSH <br />NAME ��TC/� 1{J�� Cs�S1 BUILD NG ADDRESS �-�Z'3 �TA��/Si'n) /��LOT #_ <br />BUILDING TYPE: COMPLIANCE PATH: <br />❑ New Residentfal: � Single Fam. ❑ Chapler 6(< 5000 Ft2) <br />❑ Remodel ❑ Multi Fam. Componenl PeAormance Ch#5 <br />�ddition � il Stories_ (s 3) Systems Analysis Ch# 4 <br />� Pofnts System Ch#7 <br />Heating System Type: <br />Eleciric: <br />�Base board OForced air turnace <br />�Heat pump �Zone heaters <br />� Olher <br />,. .a'�'�..liA x :ais.c�es,.4�'t➢m'XmYF�: �g,'�" ,:%! ,: <br />NOTE: A11 non-electrlcalry heated <br />dwelllnps must comply wlth the <br />1986 Washlnpfon Stafe Energy <br />Code and ofher ordlnances ol fhls <br />jurisd(cHon. <br />NWEC plan revlew: (oepanmern uso orny) <br />`Approved by Date � <br />WEE9 APRIL YO <br />Page 1 of 7 <br />