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C11 <br />u l <br />`' `J <br />DateI (0q I _.....................-- <br />Application/Permit <br />Owner <br />She Address <br />Assessor's Property Tax Account No__ <br />oI <br />C/ 3 <br />• Site Address....... a ul .O�?.•..•..- .., <br />Owner's Address.. ............I. <br />.......... ............................ ................. un <br />® <br />SayF <br />v�(S7Xuc4? !Address.......... <br />Builder..................................L <br />....................... . <br />City................................................................................................. <br />Zip <br />• <br />• <br />PROJECT DESCRIPTION: <br />O New <br />Remodel <br />G Conditioned Sq. ..`..... <br />©Q <br />FU URCE: <br />kof"- <br />HEATING SYSTEM TYPE: <br />O Baseboard <br />• <br />O 011 <br />all heater <br />• <br />• <br />O Gas <br />O Furnace AFUE................... <br />Y Y <br />La WPISE PE 31 a E NTIAL <br />COMPLIANCEAPPLICATION <br />" <br />•� brr� t.lk[ <br />i/C��;i{,,,.........h!/.- ,.......9Az 03 <br />..... <br />...Zip..`�..��. 5� .Phone ................................... <br />................................................................................. <br />...... Phone........ 3�.3-. Z 35..r................... <br />p Ingle Family I of Stories .........:............ <br />O Multi -Family I of Units ......................... <br />O Heat pump HSPF .............................. <br />OOther ................................................. <br />O Total installed watts or BTU's ............ <br />• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • <br />Check one of the Compliance Option Boxes below. Insert the values into box number 4. Before completing this <br />section refer to the instructions on back of form. <br />Electric - Northwest Energy Code, <br />Chapter <br />O Well Insulated Floor <br />O Systems Analysis, <br />Option <br />CC/hapter4 <br />Performance, <br />O Well Insulated Wall <br />0,domponent <br />Option <br />Chapter <br />O Passive Solar Option <br />O Component Point System, <br />O Heat Pump Option <br />Chapter 7 <br />FOR DEPARTMENT USE ONLY: <br />Amcurn of Payment $ ......... I ............................ <br />Date Permit Issued — ...................................... <br />Date Permit Finaled............. ........... <br />..........:...... <br />I hereby certify that this dwelling was built in <br />compliance with the NWEC. <br />or <br />......Aumo't'h-o.n:ed........A..gen.....t..........._........... <br />BuiMinp Otticul <br />Other Fuel Sources - <br />Waahinglon Stab Energy Code <br />O Prescriptive Approach, <br />Chapter 6 <br />O Component Performance <br />Approach, Chapter <br />O Systems Analysis, <br />Chapter 5 <br />COMPONENT <br />Flat Ceiling <br />Vaulted Ceiling R............ <br />Wall R... .A.. <br />Below Grade Wall: <br />interior R............ <br />exterior R........ .... <br />Floor R..,3. <br />Slab on Grade R............ <br />Doors & Frame U............ <br />Glazing <br />%Glazing'% <br />Solar Allowance , .......... % <br />Air Leakage C�TD OADV <br />• • • • • • • • • • <br />I heretryunity that the structural panels will meet the NWEC Formaldehyde requirements -either the <br />HUDrtandu sor rrurked'extennt <br />0wq fr qr Aut 1 e' / Ven� / e r' <br />i/ ...... ]....�.....C�...........m.. <br />Pnn; Name <br />:gnaWre <br />The 1n,,l iuncA'vtim/eleG[ic uttlity will make a uavmeht to either tie builder orowner tear new`lectrle <br />NOTE: An IRS Form 1099 will be sent at Ine end o1 ttie year. <br />