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. Date_c+�1�4-�.��------- ------ <br /> AppliG�(ionlPermR/_..______ ____ <br /> . <br /> Owne�'s,��.)►_�n�_�,.__NA��sa�� •. i a w a i s e R E 5 I 0 E N T I A L •' <br /> ` �— !�I � � � ' � � <br /> SiteAddress3.1_Q.}_�iA.� �.-�. <br /> Assessor's_Property_Tax Account_No. _ , � : <br /> 'PUD PLAN RGVIEW N <br /> ..,:.,:. <br /> .,., <br /> � •..: <br /> , Site Address ....��.Q`.�.........�..'!��.'�,,,p......1.�....�.�.�........................................................................... <br /> ........ <br /> � Owner's Address.......:-�i��1�..�..........................................City....................................Zip....................Phone................................... <br /> Buildor.........................................................................Address.......................................................................................................................... <br /> • <br /> � City.................................................................................................Zip....................................Phone................................................................ <br /> • <br /> • PHOJELTOESCpIPTION: <br /> ; O New C�R��titn inple Famiy /of�'ories..._�........... <br /> � Q Remodel G Corditi�ned Sa.Ft..................... O MuRi•Famiy /of Units......................... <br /> FJ{�SbUHCE: HFATINGSYETEMTYPE: ' <br /> dElearic O��eboard O Heat pump HSPF .............................. <br /> � O Oil C7Wal1 heater O Other................................................. <br /> • O Gas Q Fumace AFUE................... O Total installed watts or BTU's............ <br /> • <br /> • <br /> • <br /> • � . . . . � � � � � � � � � � � � �� • � • . � � . . . . . � . � . � � . • � . . . � � � . . . . . • � <br /> �� � , � �, � COMPONQIT <br /> Flat Ceilinp R.�.1� <br /> Check one of tl�e Complunx Opdon Bwes Mbw.lisert Ihe v�lues inro boz number 4.Before comple�inp Ihis Vaul�ed Ceilia� R........ .. <br /> section rcfer ta the instrucfioixnn E�ck ot torm. Wall R.�.�.. <br /> Ebcfrle•Nohhw�tt Enaq�Cod�, Oth�t Po�I Sourns• Below Grode Wall: <br /> Chiptw 6 Wiehinplan&�h Enup�Cod� interior R............ <br /> p Well Insulated Floor O Syntemt Analyeis, O Preacriptive Approach, exlerior R........ <br /> Option Ch�pter 4 Chapter 6 Flaor �+...+�..� <br /> O H1eli Inau!ated Wall (j'Lromponent Performance, O Component Pe�formance Slab on Grade R............ <br /> Option Chapte�@ Approach,Chapter 4 Doore 8 Frame U.......... <br /> O Passive Solar Option O Cempenert Point System, O Systems Anaysis, Glazinq U!�F�•y <br /> Chapter l Chapter 5 •hGlazinp ��+.�.rti <br /> O Heat Pump Option Solar Allowance ..........!h <br /> AirLeakape Gl�f6 OADV <br /> • <br /> o . . . . . . . . . . <br /> FOHOEPAHTMENTUSEONLY: � ' � ' ' ' � � ' <br /> Amoum ol PaymeM E...................................... I hercby ur(�Iy Cut the stNCNrrI panels w911 meel the NWEC Fortmldehyde repuircments-ei�er C�e <br /> � HUDsWdorQsorrrurked'ezterinfor'exD�um1.' <br /> Date P¢rmd Issued......................................... <br /> Own�r or�ntha��d ApenL• <br /> ..................................................................... .................................................................. <br /> � Ptint Nune SipnaWre <br /> Date Permft Fnated........................................ The loni�urisdkuonieiecuic uniiy win m�ke�yaymenl ta eitl�er me builder or owner for new elxtrir�ly <br /> � he�ted residences.Permit must be issued by 17J31H1 and conslrucAon BnaleE by N30N2 in cNer ta <br /> I herehy certify that ihis dwellinq wae buiR in 4W��'�or p�yment.To tadlilate p�ymml,Ihe foilowinp iniortna6on musl be filkQ oul canpletelY_ _ <br /> campliancewAhlheNWEC. Mailehecklo:(pleaseprinq (ADDITIONS/RGDIODL-LS N01' ELIGIBI.G) <br /> .................._............................................_........... <br /> Ntme................................................F¢d.Taz ID or SSl...................................................... <br /> BuilGinp Otliwl or/wNorized AOent Address................................................................................................................................. <br /> ....................................................._.__......_._........ City....................................................................................... Zip......................................_.. <br /> D�te <br /> NOiE:M IHS Foim 1099 w�p M sent at I�e enA o1 tAe�eu. <br />