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xr� <br />r� n <br />>H <br />A�7x <br />� H <br />a Hx tn <br />H r� � <br />y zH <br />K � <br />H �1 <br />oxo <br />� H '�J <br />Cn H <br />C' O C�7 <br />oHd <br />��g <br />ay� <br />r z <br />�y C�/� y <br />Q H <br />c� t7 � <br />��m <br />H O [N!� <br />'' � <br />� r <br />�� <br />w �a1..ta..ln.. -...ia u <br />FORM INSTRUCTIONS: <br />Please read before completing (orm <br />��`j � f` F(L in all shaded fnformaUon boxes that apply to your proJecL DonQl place marks in the two left side <br />�r^•�: columns labeled " COMPLIANCE REQUIRED" and "INSPECTION APPROVFD". Since this torm <br />wili be evaluated ior completeness, you can avo(d unecessary permit delays by carefully providing all <br />required inlormation. You may disregard inlormation requestes that don't address your particular <br />building or equipment. <br />Staif inembers will help with general questions about filling out this form. However, it is your <br />reponsibility to provide specilic iniormation (or heating systems, glazing, insulation, and other <br />building specifications. For specific requirements, refer to the Northwest Energy Code, 1987 Edition. <br />This form will ultimately be ihe basis tor all NWEC field inspections. You can avoid problems by <br />seeking approval for any substitutions belore incorporating them into the project. The building oHicial <br />may require ihat you substantlate compliance claims about building products or techniques by <br />providing documentation irom approved testing agencies or code authorities such as ICBO. <br />When your permit is issued, you will receive a copy of Ihis form. Boxes will be checked under <br />"COMPLI�NCE REOUIRED" (ndicating NWEC reouirements that must he incorporated (nto this <br />project. [ach checked requirement wili be evaluated by the building inspector and , when deemed <br />acceptable, niarked approved in the "INSPECTION APPROVED" column. <br />DATE � '1- `l � Cily �-�`-"�!' Cou <br />NAME O/�✓� I"��+/�-S` ^� BUILDING ADDRESS ��5 � � ���K ��LOT #_ <br />A I I BUILDING TYPE: COMPLIANCE PATH: � <br />.a� <br />��; ❑ New ResidenUal: Single Fam. Chapter 6(< 5000 Ft2) <br />'�„ ,� � ❑ emodel ❑ Mu1ti Fam. Componont Pertormance Ch#5 <br />��� 1 � �ddiUon ❑ N Storles_ (s 3) ❑ Poinls Syslom Chri7 � 4 � <br />�� <br />Heating System Type: <br />Eleciric: <br />�Base board (�Forced air furnace <br />Heat pump �Zone heaters <br />Other �C� U i/�''� <br />NWEC plAn revlew: <br />Approved by <br />use or <br />Da te <br />NOTE: All non-electrlcafly heated <br />dwelllnps must comply wfth the <br />1986 Washington State Energy <br />Code end other ordlnances ot thls <br />juriadlcNon. <br />WEES APHIL GO <br />Page 1 ot 7 <br />