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�01E'___"'I--//V_/�(. ._...."'"'_ ' ........... . - .,,,�.e.2:r �w. <br /> �NEROY�COO�J;' . <br /> APPlicationlPermA/--------_..----.-. ------._...__._ • . . . ` . <br /> Jp �p o.,� '•:�. .� ;;: <br /> Owner_���ReiF._� ���'IIL.SY` L0WN15E R [SIOENiIAL ,.' <br /> �'"_ <br /> o � . i � • • � 1 <br /> Sile Address._�.I_L...P__.._.__�G1�H I fP---1./.v <br /> ;:. � r,� �<F <br /> /� �.:,. .: <br /> �Assessor's Property. Tax. Account_No, �p �� -' v��"�2—��Zfs � ' � <br /> 'PUD PI,AN RL•VIf:l9 N0. I�I.3� <br /> , Silc Address .........f.J_�..v...........��.2..l...!Q:�!� �� .. .. ... ........................................................ <br /> �..................�........................................ ... .. . ��y�, <br /> Uwncr's/Add�ress.........S�A�E.............................................Ciry..�!�GF7 Ef�......2ip .��fl..�h.Phonc..�S..C�.�.....-Z�,!,7 <br /> , �:. � Builder.GP...�a.`r....��1/...!G2il�...�.�.fo-........Address...�G�„ /..�'7�6. ........�....................................................................... <br /> .................. .. ` <br /> � Ciry...�.rGr....^...l..f.�.......�Ct.�l�..............................ZiP..'?�f.Z..........Phone......�.�.J....�J..S...�S................. <br /> . <br /> . <br /> . . <br /> . � . � , aa-aern-.acssc:aw:vasau;-�wnoecwr- . .�,anre�r.�n.xx�mcwmnr� <br /> • PRO'iLT OESCRIPTION: <br /> �� �New dGition .�/L mple Family �of Stories..........:........... � <br /> � � U Remodel G Canditianed SQ.Fl..................... O Mutti-Family /ol Unils......................... <br /> FUEiSOIIpCE: HEATINC SYSTEM TYPE: ' <br /> �'Eledric O Baseboard O Heal pump HSPF .............................. <br /> ; O Oil O V/all hcater O Oiher................................................. <br /> . � Gas O Fumace AFUE................... O Total instelled wans or BTU's............ <br /> . <br /> . . �-rss,—�.:.. . <br /> . <br /> . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <br /> v �zv �,� <br /> � �, i , � , � LOMPONENT , c/ <br /> fWt Cciiing R...3.'..0.. <br /> Check one ol Ihe Compliance OOtion Bozes below.Insert ihe values into boz num6er 4.Belore complelinp Nis Vaulled Ceiling R......�.}... <br /> � seclian reler ta Ihe inslrucEons on back ol�orm. r �� Wall R...�.1.... <br /> Below Gradc Wall: <br /> � Elec(�ic-Narthwest Energy Lode, Olher Fuel Sou«es- interinr R............ <br /> Lhapler 6 � � Wachinqton Slale Enerqy Code <br /> Q Well Insulated Floor O Systems Analysis, O Prescriplive Approach, ex;xrior R... ....... <br /> Option Cypter 4 Chapter 6 Floor R...�� <br /> O Well Insulated Wall C�Component PeAormance, O Cornponent Performance Slab on Grzde R............ <br /> Oplion . � Chapter 5 . Approach,Chapter 4 Doors 6 Frame U.:.y.`t. <br /> O PassNe Solar Oplion O Cempener.t Point System, O Systems Anaysis, Glazinp U.,r..'Y.�� <br /> O Hea�Pump Op�ion Chap�er 7 Chapter 5 Y Glazinq .,;!�.�/. <br /> - SolarAllowance ...........h <br /> . AirLeakaqe C�'STD OADV <br /> . �, . R_,.____,..�..._ <br /> � _ <br /> .,� . . . . . . . . . . <br /> � � FOflbEPARTMEHT USE OHLY: � ' � ' � � %� " � ' <br /> � Amoutrt ol Payment S .:.,.:... ...�......: I hereby cetlily U�I Ne sWCNraI D��eLc will meel the NWEC fortnaldehyde reQuirements•ei4�er Ne <br /> � � � � � . � � HUD slandards or mahed'exterinf or'esposure 1' . <br /> �' � � � � � ���; Owner drAulfiori:edAqent: . <br /> Dale Permit Issucd..... ........ ....... <br /> ................................................................... .................................................................. <br /> . .. . PrinlNarne SiOmWre <br /> �Oale PermA Fnaled. ........... ............ The IoW jurisdicaon/elecuk uoliry v6n m�ke�p�ymenl to eilher Ne buiWer or owner lor mwelxlrinR� <br /> - �� he�led iesidences.Permi�must be rssued by 1Y31Ni md construcuon finiled 6y dk192 in order la <br /> ' � � � pu�lity lor p�Ymenl.To Bcilihle pryrcen�the lollawinp in{oim�nan must be filled oul compklely. <br /> Iherebycertifythailhi3dwellinqwasbuitlin "Mailchecklo:(p�e�sepiim) (qDDITi0N5/RL�IODGLS NOT LLiGI6LG) <br /> � compluncc wAh Ihe N1'IEC. <br /> . � � Name................................................Fcd.Tax ID or SSI...................................................... <br /> � ......�..._......._............................................_........... <br /> BuildinpOtlici:lo�fwCoritedApenl Address................................................................ <br /> ...:............:.................................. �--::..:._.....:.. Ciry........................................................................................ Zip.......................................... <br /> D�le . - � . . . <br /> NO1F:la IRS Pom 1 CM��i Fe vnt�i Pe en:pf�e�ar. <br />