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Dale ..._.."l.l._�_3`Cl�._..... ...__.� .. <br />AOPlicationRerR n / ..__...__�_y.__�____...�_. _.._.'__._._ <br />Owncr �[1+-�LVP��-__.._.._ ....... <br />siteAda�ess__�,Qb��r�tr-.�-�-'r'� t� <br />is� n�sio <br />B <br />Sdc Addrcss ....._b.0..�r.......�..hQ �..�0:.^.�....�OSr+.�i....... ...� ....................................................._............ <br />� 1 <br />Owner's/A�d\dress ........�...�...�............../..�.�......../...�..�...............................Ciy....................................Zip........__........Phone................................... <br />0uildcr.:1.1�!u.a .✓..':.:a)��.....115!.�e.LU.�Address .......................................................................................................................... <br />Ciry................................................................................................. Zip.................................... Phonc................................................................ <br />...� <br />PHOJECT DESLflIPTION: <br />O New Gition _ QSiTIc Famiy � ol5tories......1 ...:........... <br />O Remadel anditioned 5a. FI. J.3.�I.... O hluhi�Family � al Uniis ......................... <br />� FUELSOUflCE: <br />O{feclric <br />' O o�l <br />. <br />O Gas <br />. <br />. <br />•����������• <br />HFATIHG SYSTEM TYPE: <br />O Basebmrd U Hmt pumP HSPF .............................. <br />0'Vallheilcr . OOther ................................................. <br />O Furnace ANE ................... O Tolal inslalled watls or BTU's............ <br />........�� .................�............ <br />CMck ane c1 Me Com0luna Oplion Ba.es Celow.lnsul Ne v+lua in�o baa numOtr /. &lore comDletinp Ihis <br />seGian �der Io IM instrucuons on hack ol lo:m. <br />Eieatric • Nodhwes� Enerpy Code, <br />Ch�pler 6 <br />Q Well Insulaled Flaor O Syslems Anaysis, <br />Optian �CAapler4 <br />Q Well Insulated Wall l7 �ampanen� Pedarmance, <br />Option . Chapler 5 <br />O Passrvc Salar Oplion � Cempencr.l �aint System, <br />OHc�tPumDOption Chapter7 <br />FOfl OEPFHTMCHTIISEONLY� <br />Amoum ol Payment 5 ...................................... <br />Dalc Pcrmd Issued..._ .................................... <br />Dale Pe�mil Fnated ......................................... <br />I hcrehy ccnity thal Ihis dwdiinp was 6uitl in <br />com plqncc wAh the NWEC. <br />.................._.......... _..........................._..._........... <br />BuiMinp OHicul or W maoaE Apenl <br />.._.._ ............._.....-._.__....._-.,__�........ <br />D�Ie <br />Olher Fuel Sourcec - <br />Wo:hingtan Sl�le Enarqy CaCe <br />Q Prtscrip�Ne ADPraach. <br />Chapler fi <br />Q Component Pedormance <br />App�oach, Chapter 4 <br />O Systems Anaysis, <br />Chapter 5 <br />comroxexr <br />Fut ceilinp � p.��..�..�.. <br />Vaulted Ccilinp R............ <br />waii ndl�A <br />Bclaw Grodt Wall: <br />interior fl........... <br />e�terior P............ <br />Floar F.3_Q <br />SubonGrade p............ <br />Ooois d Frame 11............ <br />Gluinp U.:SD <br />kGluinp .�.y�b"'4 <br />So�atAlloxancc .....:k <br />AirLralwqe 10 OADV <br />•.••.••.. <br />1 herebY uniN �+I Ne slmcNiv p�ncls K+11 meei iM NWCC Foim+Uehyde re0uiremen6 • tiiher Ne <br />tN0 sW EUCs ar m�rteC'alennY o�'e�posmt 17 <br />Owner orAulhorhed AQent: <br />. .................................................................. <br />. ........................._................................... SOn�Wrt <br />i'nn1 Name <br />TlKlool'rynsEi[OonQIttVKu�lityvnllm��e1 p�ymenlloeithei�heEu�Nno�ormeilornewdxlir�lry <br />hmlN mstlennz. Perm�i must De issued Gy 1Y191 md cons�nx.00n fin�kd �y NJ0A2 m obet la <br />pwlAylorpiYmmt.TohulNleprymenl,Nelollornnpinlorm�6onmuslDefilkEouicanpklely_ _ <br />Moilchetkio:(pkutOnml (i1UU1llORS/IiIiFIDUCL:; 907 IiI.IG1IlI.li) <br />Name ... <br />Address <br />(ed. Tu ID oi SSi <br />