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� <br /> � ' � � � 2320Ca1i/ornia�St., Everett, Washington 98201 25R_-&211 <br /> . . i <br /> . Mailing Address: P. O. Box 1 f07, Everett, Washingtcn 98206 <br /> �� <br /> Snohomish PUD Reference ONLY <br /> Energy Plan Review �r : (� S- !) /3� <br /> ��NWEC�� Plan Review and Compliance for Electric Heat Residences <br /> Date: 9 -I� ^ / `=' <br /> Plan Check No: 4J/2560/ <br /> Assessor's Property Tax Account No: <br /> Jurisdiction Basic Plan #: <br /> Builder: W�!��� l��7/�!F"5 <br /> Address: //[,p7 �7-. L. S - <br /> City: LA/cE S7EL�i✓S r l,/!+. ��f3 <br /> Phone: 334�-/�4 I <br /> Single Family:� <br /> Multi-Family: _ Suildings:_ Units:_ <br /> site xadress: � 9 �� 1'IEQ�� IAA) ��� _ <br /> Compliance: Chapter 4-Systems Analysis_, Chapter 5-Component Performance� <br /> Chapter 6-Prescriptive_, Chapter 7-Component Point <br /> Note: See attached documentation for energy requirements <br /> Snohomish County PUD �1 Representative: I �?. i'�"'�-- <br /> ignature <br /> �°Nr/ f-� LAK€ ?Sg S27 Z <br /> Print Phone <br /> �ITEMS BELOW ARE TO BE FILLED OUT BY THE APPLZCANT* <br /> ---------------------------------------------------------------------------- <br /> Builder / Consumer Payment <br /> Owner or Authorized Agent: 1/X �" C �lia/yt�2c€ ��GNIa �G /C /�( <br /> Signature Print <br /> Mail Check To: Amount $ _ <br /> Name: <br /> Address• <br /> City, St. : <br /> Tax Id. n or SS� : <br /> Note: An IRS Form 1099 will be sent at the end of the year. <br /> t <br /> N O R� �f+cAd,C,��"!¢__rrt2 <br /> ENERGY CODE -•.>��:����<•=•��.�__. <br />