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; <br /> , <br /> ,_� y� /- <br /> � Date---._...-------2-13_91 '� <br /> ApplicalioNPemii[/.__._..._._..._._...---__......----------- .::.. .•:•.� <br /> L �u :. <br /> I {- � "., L 0 W P I S E N E 3 !0 E N T I A L ;' <br /> OWIIEf..___...._.__.._......._I__1.��_.__�.�_4.�f1l�v�. <br /> Z� ..�� ILTnN'J L�d ADP• 1 • ' ' • • ' 1 <br /> Site Address__�-0_T___�0.'.�.�..___��K.._......$.....__._..1'� <br /> �:.;:. ,,:,.: <br /> Assessor's Pro ert � Tax_Account No. �"�' <br /> ---...-----._....___.._._P_---.2.._.__ ............................. ..:.•::::,� :,-:::,. <br /> 'PUD PLAN RGVIBW N0. 0691017 <br /> • <br /> • <br /> , Site Address ....................................................................................................................................................................................................... <br /> Owner's Address.............................................................................Ciry...................................:Zip....................Phane................................... <br /> � Builder...Duane Drandvold..............................Address......................................................................................................................... I <br /> .................. ... . <br /> ' Ciry.................................................................................................Zip....................................Phone.568-9342 <br /> � .......................................... <br /> . <br /> . <br /> . <br /> . <br /> . <br /> • PROJECTDESCfl1PTI0N: <br /> � � New O Addition �Sinple Famiy /of Stories.....�...:........... <br /> � Q Remodel �i Conditianed Sq.Ft.....9.$4......... O MuRi-Famiy I ol Units......................... <br /> FUELSOURCE: HFATINGSYETEMTYPE: ' <br /> � Eleclric O Baseboard O Heat pump HSPF ............................. <br /> � O Oil �Wall heater OOlher................................................. <br /> . Q Gas O Furnace AFUE................... O Total installed watls or 6TU's............ <br /> • � <br /> • ' <br /> . <br /> . � � . . . . . � � . � � � . � . . . � . � • . . . . . . . � . � � � . � � � . � � � . � � � � . . . • � <br /> •� �i � <br /> • � � • � <br /> COMPONENT <br /> Flat Ceiling R. ......... <br /> Check one ol Ne Compliance Option Boces belaw.Insert tl�e v:Jues iuto boz number 4.Before completinp Ihis Vaulted Ceiling R............ <br /> seUian mhr to ihe instrucdomon h�ck af lorm. Wall F;21,,,ADV <br /> Below Grade Wall: <br /> EI�NrIe•Northwat Enetyy Cade, Olher Fuel:ouree�- interior R............ <br /> Ch�pla 6 Wachfnqton St�h Enuqy Coda , <br /> Q Well Insulated Floor U Systems Anaysis, O Prescriptive Approach, exterior R............ <br /> Option Chapter 4 Chapter 6 Flaar R.2.2...... <br /> p Well Ineulaled Wall C� ComponeN Pedormance, O Componem Pedormance Slab on Grade R............ � <br /> Option Chapter 5 Approach,Chapter 4 Doors 8 Frame U..22... I <br /> O Paseive Solar Option �J C^mpener.t?oint System, O Systems Ana�sis, Gluinp u.:.4n/...4 GD <br /> Chapter7 Chapte�5 °�Glazinp .1.�,.N% <br /> O Heat Pcr. �Option Solar Allowance .........../o <br /> Air Leakage Q STD O ADV <br /> • I <br /> o . . . . . . . . o . <br /> FOR DEPANTMENY USE ONLY: � ' � ' ' ' ' <br /> AmaUIY,of Payment S.•.................................... 1 herehy certily thal Ihe sWcNd PaneL�will meel Ihe C FortnaWehyde reQuiremenls-eiMer tl�e 4 <br /> HUD standards or marked'exteriot rr'exposure 1' ' <br /> , Qwneror ulhorl:ed Apenl: , ,/�� � Q <br /> Date Permrt Issued........................................ �.:.�,..� c�.. � ,�=�-r�•"•'�:.......... <br /> ......�.N u..a.....sl..��:P. ....1.._��c.-Kr.. ..... <br /> PnntNune SiOnaWre `�r-+o.� <br /> DataPermitfinaled........................................ Thelo�aijurisdiction/eiecuicu6iirywium�kea paymenitoeitherthebuilderorowneriornewelectricaly <br /> healed residences.Permit mus�be issued bY 17/31A1 and consiruc�on finaled by EI30A2 in order to <br /> I here6y cehily iha�this dwellinp was buiR in -a����or p�yment.io lacililale paymen�Ihe lollowinp informafion must he filkd out canDk�dy_ _ <br /> compliancewnhtheNWEC. Mailehecklo:�pleaseprinq (qDD1TI0NS/RLPI0DCL5 NOT ELIGIBLG) <br /> .................._....................................................... <br /> Name 17...�':...s�LbC.N..�i'.::.��.........Fed.Taz ID or SSI....i..�.-.//%S 2 0 6 <br /> BuiMinp OtGwl or AUUori:ed Apent Address..S3o.7 -..1..3..I A�e sE . ................................. <br /> ..... ............................................... . . <br /> .. .... <br /> .. C' S.�r Na,in.!.S.!l..............�� .................. Zip...�.�.:�...?.d <br /> ................................................._�.._................. Ry...... . ................ ..................... <br /> Date <br /> NOTE:M IRS Fartn 1099�+ii Ca sent at Ne enE o11Te yeu. <br />