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'iYFb^ <br />Date _A-0--.7 =11 - - - <br />ApplirafionlPermN /C�_�__. <br />Owncr—__S <br />Site Address.- ---_—. <br />Assessor's Property Tax <br />R <br />Site Address ................................. ... /..T.....V......,...............,..,...a..e.r..... x................................................................. <br />.. <br />Owner'sA dress ................. ........ City ....................................Zip .................... Phone ............ ..._.................. <br />Builder...P..M(t°%.��e.l... .cartT....N.1..9.../..CV.,f Addressl..P.-. �eA...1A.��!.............................................................................. <br />city.... 'u......................r....-�..................Zip...VZOb.:�E(Y...Phone.jY.?..... %m............................... <br />PHO�IECT DESCRIPTION <br />New O Additicn <br />Remodel O Conditioned So. Fl....�1..L...`.: <br />PFUE SOURCE: HEATING SYSTEM TYPE: <br />Electric O Baseboard <br />O Oil (irWall heater <br />• O Gas O Furnace AFUE ................... <br />• amr_�c rexcxaxaz*m•®ar• <br />• • • • • • • • • • • • • • • • • • • • • <br />Single Family i of Stories.......... ......... <br />O Multi-Fainiy i of Units ......................... <br />O Heat pump HSPF ...................... <br />OOther ................................................. <br />O Total installed watts or BTU's ............ <br />Check one cf the Compliance Option Boxes below, lraert the values into box number J deloie compi0ing this <br />section refer to the instructions on back of form. <br />Electric - Northwest Energy Code, <br />Chapter 6 <br />O Well Insulated1 Floor O Systems Analysis, <br />- Option �� Chapter 4 <br />C7 O Well Insulated Prall Component Performance, <br />Option Chapter 5 <br />O Passive Solar Option O Component Point System, <br />O Heat Pump Option Chapter 7 <br />e <br />"• ^- FOR DEPARTMENT USE ONLY: <br />Amount of Payment 5................ <br />1 ( Date Permit Issued ................... <br />Date Permd Finated......................................... <br />I hereby certify that this dwelling was built in <br />compliance with the NWEC. <br />........................................... ....... <br />Building Otlicul or Authodted Agent <br />..................................... <br />........... <br />.....— — .... ........ <br />Dale <br />Other Fuel Sources - <br />Washington State Energy Code <br />O F'rescripuve Approac <br />Chapter 6 <br />O Component Performance <br />Approach, Chapter 4 <br />O Systems Analysis, <br />Chapter 5 <br />COMPONENT <br />pp <br />Flan Ceiling <br />R..3.SF.. <br />Vaulted Ceiling <br />—R........... <br />Wall <br />R.2.i..... <br />Below Grade Wall: <br />interior <br />—fl—......... <br />exterior <br />—FL......... <br />Floor <br />R-••�•+ <br />Slab on Grade <br />-k-. .. <br />Ur.....I.. <br />Doors & Frame <br />Glazing <br />Ur IQ49 <br />%Glazing <br />ly...... % <br />SolarAlloxvnce� <br />...6...°'• <br />Air Leakage 'U• <br />STD ADV <br />• <br />I hereby certify that the structural panels will meet C Forma requirements - either the <br />HUD standards or malted •extedof or'exposure 1."\, <br />Ownir r uth t d ent: <br />ecr1:..........._....................... <br />PrintName <br />. .................. Signature <br />The local junsdictionrelectric utility will make a payment to either the builder or owner for newelectricaly <br />heated residences. Permit must be issued by 11/31/91 and construction finaW4 b9 r,13OA2 in order to <br />quality for payment. To facilitate payment, the fohwing information must be filled out c0ff telly_ <br />— — — — — — — — — — — — — — — — — — — — <br />Mail Oackto:( a epdnq (ADDITIONS/REMODELS NOT ELIGIBLE) <br />yt Name aGS� 11\0........... Fed. Tax ID or SS1.... ��7. �iy:�4„�y�i....... <br />Address.. .` yiS�....����.N......�................ ........................... <br />I�N <br />CiN.........Stl`91�..................L�. i ` ._....... <br />NOTE: An IRS Fan less VAN blunt attire end of TO you. <br />mot♦ C <br />