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��� <br />��x <br />C H <br />9Hti <br />C <br />y H <br />fC C� <br />H �f <br />oxo <br />'�7 H 'i1 <br />V1 H <br />C+70� <br />H C7 <br />OH <br />H/��g <br />y� V C] <br />H <br />zy <br />�HH <br />8 �' <br />c� C7 � <br />��� <br />HOf�/� <br />r "' <br />� ; -; <br />c.l .'. r . � � <br />Activit;,,�„?ermit # <br />FORM INSTRUCTIONS: <br />Piease read betore completing form J: <br />�` �, Fill in all shaded information boxes ihat apply to your projecL Do�ol place marks in the two Ieit side <br />r,ulumns labeled " COMPLIANCE REQUIRED" ano "INSPECTION APPROVED". Since this torm <br />will be eveluated (or compleleness, you can avoid unecossary permit delays by carelully providing all <br />required iniormation. You may disregard in(ormalion requestes that don't address your particular <br />' building or equipment. <br />�' Staif inembers will help with g=neral questions aboul fiiling out ihis torm. However, i! is your <br />reponsibility tu provide specific ?nformation tor healing syslems, glazing, insulation, and other <br />building specifications. For sp��cific requirements, refer to ihe Northwesl Energy Code, 7987 Edition. <br />This torm will ultimately be the basis for all NNJEC field inspections. You can avoid problerr.s by <br />seeking approval for any substiWtions belore incorporating them into Ihe projecL The buildirg oliicial <br />may require ihat you substantiate compliance ciaims about building producls or techniques by <br />' providing documentation irom approved testing agencies or code authorities such as ICBO. <br />OWhen your permit is issued, you will receive a copy of this form. Boxes will be checked under <br />"COMPLIANCE �iEDUIRED" indicatinc� NWEC requiremenls that must �e incorporated into this <br />project. Each checked requirement will be evaluated by tho building inspeclor and , when deemed <br />acceptable, marked approved in ihe "INSPECTION APPROVED" calumn. <br />DATE��`%-`"�Clty /"VCIw// CoUOty >.v.rrcrtt�i� <br />NAME —��/� ���-�`��=BUILDING AUDRESS I3�� ��^��`�Z�`^� �urOT #_ <br />BUILDING, �T,(YPE: ,,.,( COMPLIANCE PATH: <br />L7l�New Residenlial: lX! Single Fam. [] Chapler 6(< 5000 Ft2) <br />(] Remodel � Mulli Fam. `Component PeAormance Ch#5 <br />❑ Addition ❑# Stories_ (s 3) Systems Analysis Ch# 4 <br />0 Points System Ch#7 <br />Heating SystEm Type: <br />� � ' Eleciric: <br />'? []Base board OForced air turnace <br />' �Heat pump [�Zone heaters <br />� Other <br />NWEC plan revlew: <br />4pproved by _ <br />use <br />Date <br />NOTE: All non-electrfcally heated <br />dwellings must comply with the <br />t986 Washington Stafe Energy <br />�ode and other ordJnances of thls <br />jurisdiction. <br />e w� .;. . <br />WEES APHIL YO <br />Page 1 oi 7 <br />