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Date ----2:2tia9.7._—_------- <br />Application/Permil <br />Owner <br />Site Address ------- -------- ------- <br />Assessor's Property Tax Account No. <br />L own l5E <br />• Site Address .......................... ../.....�.�..��.R....................!....................................................................................................... <br />Owner'aAddresb........ / ......... p,,,, 2-7_goo <br />® 3.1............................................. Ctly.i..........................:Z i 1K 1... Phone2 .......................... <br />Builder...Duane.....B_ra-ndvol/d............................Address... ar�.C?7.'�3.Q1� 5jff........................................................... <br />city...t.........G ................... lip s"!.Qq..0............. Phone...a...?�................ <br />• PROJECT DESCRIPTION: <br />)a New O Addition 0 Single Family / of Stories.... 2...%........... <br />O Remodel 5X Conditioned Sq. Ft. .i.6.z6......... O Mufti -Family 0 of Units ......................... <br />® FUEL SOURCE: HEATING SYSTEM TYPE: <br />Electric O Baseboard O Heat pump HSPF .............................. <br />O Oil )a Wall heater OOther................................................. <br />O Gas O Furnace AFUE................... O Total Installed wafts or BTU's ............ <br />Check one of the Compliance Option Boxes below. Insert the values into box number 4. Before completing this <br />section refer to the instructions on back of form. <br />Electric - Northwest Energy Code, <br />Other Fuel Sources - <br />Chapter 6 <br />Washington State Energy Code <br />O Well Insulated Floor O Systems Analysis, <br />O Prescriptive Approach, <br />'e <br />Option Chapter 4 <br />Chapter 6 <br />.� <br />O Well Insulated Wall Q Component Performance, <br />O Component Performance <br />Option Chapter <br />Approach. Chapter 4 <br />O Passive Solar Option O Component Point System, <br />O Systems Analysis, <br />f <br />O Heat Pump Option Chapter 7 <br />Chapter 5 <br />gli <br />FOR DEPARTMENT USE ONLY: <br />Amount of Payment 5.........._............... _......... <br />Dale Permit Issued ..... .......... ........... ............ <br />Date Permit Finaled......................................... <br />I hereby certify that this dwelling was built in <br />compliance with the NWEC. <br />Building OUcial or Autliodaed Agent <br />Date <br />nets will <br />or 'expo <br />COMPONENT <br />Flat Ceiling R38....... <br />Vaulted Ceiling R;$..se i <br />Wall R.1.y..sTD <br />Below Grade Wall: <br />interior <br />R>.0..1 i <br />exterior <br />R......... - <br />Floor <br />R3.0....... <br />Slab on Grade <br />R.1.0...... <br />Doors & Frame <br />U_i2 <br />Glazing <br />D.46Z <br />%Glazing <br />.12_11l6 <br />Solar Allowance <br />...........% <br />Air Leakage to(ST) OADV <br />• • • • • • • • • • <br />requirements - either the <br />The local junsdkdoNelectric utility will make a Gayment to either the builder or owner for new eleclrieatty <br />heated residences. Permit must be issued bhyy 17/3151 and construction finaled by 6r30A2 in order to <br />quality for payment. To facilitate Prymenk cite following information must be filled out Completely_ <br />Maieec�k�toa— x—dq—(DITIO—N—S/—RU—O—DCL S NOT' <br />OlT�i—L ,— I�B L.�—Bo.) ..— <br />..........Nam s?ep1{/4��ed. Tax ID or SSi� <br />Acidness....�53.07....-(.3..ylra,r.....6 _6 ........................................................ <br />city....., ..?........... ............... LN..%4,-....................... zip... f290............... <br />NOTE: An INS Farm 1092 •le M 34111111118 61111 of cif year. <br />SGD <br />