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Address.......................................................................................................................... <br /> ..... <br /> .......... <br /> � Ciry................................................................................................Zip....................................Phone................................................................ <br /> • <br /> . <br /> • <br /> • — <br /> • - <br /> • � -"'1;:� � tlESCpIPTION: <br /> ' ;;,�';;:: O Addition O Sinqle amiy I at 5lories..... .. .......... <br /> � * U Remodcl G CondBioned Sa.Ft..................... rFamih� /of Units......3.............. <br /> � FUEL SOUHCE: HERTING SYSTEM TYPE: � <br /> Q�llEctric O Baseboard O Hral Pump HSPF .............................. <br /> � O Oil C�1Mall heater O Other................................................. <br /> • Q Gas O Fumace AFUE................... O Tatal instcl�ed watts or BTU's............ <br /> . <br /> � 1 � <br /> . <br /> 1 ' • . . . • n • � • . • • • � � � • � •� • v • � • � • • • . � • • . . • • • . • . • . • • • • • • • • • � <br /> � <br /> � COMPONENT 2 L <br /> ' 1 �� � � � �� � Flat C¢ilinp R..wZ.Q <br /> '�' Ch?ck one ol the Compliance Optlon Bazes be�ow.Irxeh the vyues inlo box number 4.8efore comdelin0�is Vaulted Ceilinp R...... .. <br /> seclionrefertotheinsirucnoiaanbrkolform. Wall R..�.�... <br /> 1 Below Grado Wall: <br /> Elaclrie-NoAhwatt Enerpy Cod�, Olher Fuel Sources- interior R............ <br /> ' Chapler 6 Wishinpton Slole Enerqy Code exlcrior R............ <br /> Q Well Insulated Floor O Syyyssateme Anaysis, O PrescriplNe Approach, Floor R............ <br /> Option �er 4 Chapter 6 Slab on Grada R./..0.. <br /> , Q Well Insulated Wall omponent Performanca, O Component Performance Doors 8 Framn U.........r. ' <br /> �' Option Chapter5 Approach,Chapter4 Glazinp U.�...yM S <br /> � O Passive Solar Oplion O C^mpeneM Point System, O Syslems Analysis, °�Glazinq .........."h <br /> O Heat Pump Option Chapter 7 Chapter 5 S,WrAllowance ' <br /> �' ...........� <br /> � Alf Lcakagc C�,GtO"O ADV <br /> �/ • <br /> o . . . . . . . . . . <br /> '�I FOH UEPARTMENT USE ONLY: � ' ' � � � � <br /> - Amount ol Payment 5...................................... I hereby urtify tluI Ihe slNCNnI p+nels will meal the NWEC Foimakehyda reQuiremenm•either Iha <br /> HUD standards or muked'exlerinf or'exposure 1' <br /> OwnerorAulhwliedAqenL• �� � �� ,C� <br /> Oate Permit Issued......................................... J A��E s E . IC Y�:E.......... ....J........................... ...�.................. <br /> ..................................................... SipnaWre <br /> Print Nune <br /> Date Permit flna�ed......................................... The loal lurisdicoon/elecUk u61iy wiii mate a paymenl to eitl�er the builder ar owner lor new eleclriwly <br /> he�ted resdences.Pormit must 6e issued by 17I31A1 and consirucuan finaled 69 N3092 in order to <br /> qu�IHy lor p�yment.io ladli�le F�ymen4 Ne Iollawin0 inlormauon must 6e filled out canD��e�Y_ _ <br /> Iherebycertilythat�hisdwellinqwashuiNin Malleheekto:(pleaseprinq (pDDITI0N5/RGPIODCI,S \OT I:I.iGI11LG) <br /> camplWnce wrth the NWEC. <br /> .................._............................................_........... <br /> Name................................................Fed.Tan ID or SSY...................................................... <br /> Buildin00tficialorAuthoritedApanl Address................................................................................................................................. <br /> ..................................................._._........._........... City........................................................................................ Zip.......................................... <br /> Date <br /> � NO1E:M IHS Fortn 1099 vnll Ea sent al Ne enA ol IAe year. <br />