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` Daie:_���_5���___ <br /> - . <br /> APPliwtion/Permit/----------------------- . <br /> •:. . <br /> �/'�,,�C ::• :::� <br /> �W�ef_�^l\.1.���___,.._____�___ "., L 0 W R I 5 E R E 3�D E N T I A L •' <br /> Site Address_�.��_�(,���5�� I � ' ' ' ' ' � 1 <br /> �Assessor's_Property Tax Account No_ ' � . <br /> --- --- --- ------------- <br /> :::, _:;• <br /> �PUD PLAN REVIEW N O <br /> .,:,.::; <br /> � M typ .. <br /> • S8e Address .....I...�.�..L�......l..:!.�lP�:...E!i�r'�,-�.....u�� f f/'�O� <br /> ..... ................... .................................................................................. <br /> /S/`� M� , ,.�..�� �/�9ll.toi 29P;,-,/zso <br /> Owner's Address.......................................................................City...�..........................Zip...................Phone.... . ......... <br /> / .... <br /> - Builder.�G✓✓(Y.�....TK.N.r^.i`.o.!....................Address...........1.5. !.9 � � <br /> .. .............aa.. ............................................................................ <br /> . . y <br /> . Crty...��r.�t.�?.`:....................�1.......................................Zip....�.P.'.z.��............Phone......��..�J..�..—.../.�,30......................... <br /> . <br /> . <br /> • PHOJECT DESCpIPTION: <br /> , O'I� ddition nqle Famiy /of Stories......�.:........ <br /> � O Remodel �nditioned SQ.Ft...��..... O MuNi•Famiy f of Units......................... <br /> FUEL SOUHCE: NEATING SYSTEM TYPE: . <br /> ectric seboard O Heat pump HSPF .............................. <br /> � O Oil O Wall heater <br /> • O Other................................................. <br /> • O Gas O Furnace AFUE................... O Total installed watts or BTU's............ <br /> . <br /> • <br /> • <br /> . • • • . • . • • . � • • • • • . . • • • v . • . • . • . . . . . . . . • • . . . • • . . • • • • • . • <br /> � <br /> � i� i • � � • i COMPONENT <br /> Flat Ceilinp R.�;�:. <br /> � Check one of the Complunu Option Boxes below.I�uert ihe vyues into hoz number 4.Eetore complelinp this Vaulled Ceilinq R...ti�..� <br /> seUion rcier lo the instructioreon bxk al fortn. Wall R.,ar.1,. <br /> Elulrie•Northwe:t Enerpy Code, Olher Fuei Soureas- 8elow Grade Wall: <br /> Chapt�r 6 W�chinplon Stole Enerqy Code interior R.,.,........ <br /> p Well Insulated Floor O Systems Analysis, p PrescriptNe Approach, exteriar R............ <br /> ' Option Ch 4 Chapter 6 Floor R�.S <br /> p Well Insulated Wail omponent Per(ormance, O Component Perfarmance Slab on Grade R.....,...... <br /> Option Chapter 5 Approach,Chapter 4 Dooro d frame U.t.�,e,. <br /> O Passive Solar Option O Cempener.t Point System, O Systems Anaysis, Glazinp U.;.37�`� <br /> O Heat Pump Option Chapler 7 Chapter 5 '�f,Glazinp �.Y..�.7'� <br /> SolarAllowance ..........!k <br /> AirLeakape (3.SiD�6ADV <br /> • <br /> o . . . . . . . . . . <br /> FOp DEPAflTMENT USE ONLY: i � i � • � � i � <br /> Amoutrt of Payment 5..................:.........:........: I here6y urtily tlul Ihe stmcNnl p�neis will meet Ihe NWEC Foim�Mehyde repuiRmenls-eiNer Ihe <br /> � � � � HUD snndards or nurked'ezteriot or'exposure 1' <br /> Date Permit Issued.. ..: Q ner or�uf6 ized Ap nl: <br /> .. .................................. �� <br /> .LJLl��CA..�1'.1��,��..................... ����.� . . .. ... ................ <br /> Print Nune pnaWrt <br /> Date Permit Fnaled........................................ The loul jurisdktionklectrk uuliry wiu mue�p�ymmt to eilher the buiker or owner(or new elxtricalry <br /> . � � � hated residences.Peimil must be issued by 1?/31A1 znd wnstiucuon fin�kd by fiJ30A2 in arder to <br /> I hereby certify ihat this dwellinp was buiR in QWliy lor p�yment.To luiliute p�yment,Ne tollowinp information musl be filkd out compktdy_ _ <br /> compliancewrthlheNWEC. Mafleheekto:(pleaseprint) (pUDITIONS/REDIODGLS NOT ELIGIBLE) <br /> .:......._......._......................... ................._........... <br /> Name................................................Fed.Tax ID or SS/...................................................... <br /> � BuildinpOtfiwlorAulhoritedapent Add�ess................................................................................................................................. <br /> ..............................::............_......._._.._....__........... Ciry........................................................................................ Zip.......................................... <br /> o�� <br /> NOTE:M IHS Fortn 1099 Mill M sent�t Ne enA ol Ne�ear, <br />