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��� <br />��x <br />q H <br />�Hy <br />y�H <br />FC n <br />H xl <br />�H� <br />�� <br />�z <br />HC <br />ON <br />H�g <br />�� � <br />t" y x <br />�-+ H <br />� <br />�e� <br />�o� <br />�; �'-, JD ` <br />ACtIVi <br />/Pe' a�it # <br />,.. <br />.._ ..__ <br />a FORM INSTRUCTIONS: � ,` Please read betore completing form �.�y\ .\ <br />. � _.. _ ...... <br />....<,��,,.r.o, <br />Fill (n all shaded intormation boxes that apply to your project. l�n.not place marks in the Iwo leit side <br />columns labeled " COMPLIANCE REQUIRED" and "INSPECTION APPROVED". Since ihis form <br />will be evaluated tor completeness, you can avoid unecessary permit delays by carefully providing all <br />required iniormatfon. You may disregard information requesles that don't address your particular <br />building or equipment. <br />Stait members will help with general questfons about tilling out this lorm. However, it is your <br />reponsibility to provide specific intormation tor heaiing systems, glazing, (nsulation, and other <br />building specifications. For specific requirements, reter to the Norlhwest Energy Code, 1987 Edition. <br />This torm will ultimately be the basis tor all NW EC field inspections. You can avoid problems by <br />seeking approval for any substitutions 6efore incorporating them into the project. The building official <br />may require that you subslantiate compliance claims about building products or techniques by <br />providing documenlatfon irom approved testing agencies or code authorities such as ICBO. <br />When your permil is issued, you will receive a copy oi this form. Boxes will be checked under <br />"CJMPLIANCE REDUIRED" indicating NWEC requirements that must be incorporated into this <br />projecl. Each checked requirement will be evaluated by the building inspector and , when deemed <br />, acceptable, marked approved in the "INSPECTION APPROVED" column \ <br />DATE /'� i--i�-cny �— - - <br />�'-iZC E I-IfiMH=��P� BUILDING ADDRESS �`� � r ���^�rr2 �v �OT k_ <br />NAME ' <br />BUILDING TYPE: ,�,( COMPLIANCE PATH: <br />l: i Single Fam. Chapter 6(< 5000 Ft2) <br />❑ NeW Residential: �,Com onenl PeAormance Chq5 <br />�Remodel '� Multi Fam. P <br />Additlon � t1 Slories._ (s 3) � Poinis SystemSCh#7 � 4 <br />h�,� � � .. .:.:, �, . a.. <%..�. . �x :...;. � .. . .� ::::.. ... . . . ... _. . <br />�Heating System 7ype: NOTE: All non•electr7cally heated <br />a dwellings must comply with the <br />� Etectric: 1986 Washington State Energy <br />`Q]Base board �Forced air turnace Code and other ordlnances o/ thls <br />z 'dHeat pump �Zone heaters jurisdiction. <br />� DOther ;,��,,,.���� ?��: <br />, <br />s: <br />�u ..... .�:;,._. ,. <.... ..,�;�,:mr�. ,,. .:..-: <br />WEE9 APNIL YO <br />(Deparlmenl use oniy) <br />NWEC plan review: Date <br />Approved by Page 1 ot 7 <br />