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yeya C�H <br />C H <br />�xyHx Cn <br />tHz� <br />0=0 <br />i1Hty <br />En H <br />H <br />z <br />o� <br />� M8 <br />,0. 0 <br />AHI <br />H H <br />8rA <br />H <br />n C N <br />2Hrn <br />HOrn <br />MIN <br />Date ....._Lt%1lH..l. q <br />_ � tl:n�Taxzcl3oc <br />Application/Permd / ___._-... _____.. ...... <br />LrowR ISE RESIO EN <br />Owner <br />Site Address .4 3........S4w6rkrs -1," <br />Assessor's Pronerty Tax Account No. <br />She Address .......... /..,'...!.ti..r......,..J.164M .,,..r.................. .—.......... .,.......... ..................... <br />Owner's Add ss .......................... city ............ I....................... Zip..... ............... Phone................................... <br />Builder.. Address.............................................................................................................._....... <br />IF <br />City.............................................................................. ..................Zip.................................... Phone ................................................................ <br />• <br />PROJECT DESCRIPTION: <br />• <br />"(ew <br />Q Remodel <br />I ®FUEL <br />SOURCE: <br />molectric <br />O Oil <br />O Gas <br />O Addition <br />ibf Conditioned Se. Ft. Iall.. <br />HEATING SYSTEM TYPE: <br />O Baseboard <br />"all heater <br />Q Furnace AFUE................... <br />Ingle Family I of Stories .... ......... <br />O Multi -Family Y of Units ......................... <br />O Heat pump HSPF .............................. <br />OOther ................................................ <br />O Total installed watts or BTU's ..._,...... <br />• • • • . • • • • • • • • • 'w7 • • • • • • ... • • • . • • . • • • • • • • • • • • . <br />Check one of the Compliance Option Boxes below. Insert the values into box number d. Before completing blis <br />section refer to the instructions an back of form. <br />Electric - Northwest Energy Code, <br />L Chapter 6 <br />Q Well Insulated Floor <br />O Systems Analysis, <br />Option <br />Chapter 4 <br />O Well Insulated Wall <br />Component Performance, <br />Option <br />Chapter 5 <br />O Passive Solar Option <br />O Cn .ppenent Point System, <br />_ _ <br />1 O Heat Pump Option <br />FOR DEPARTMENT USE ONLY: <br />Amount of Payment$..................I................... <br />Date Permit l..aed........ .... I ............................ <br />Date Permit Flnaled......................................... <br />I hereby certify that this dwelling was built in <br />compliance with the NWEC. <br />Buildlnp ONicial or Aueloriied Agent <br />Dale <br />Other Fuel Sources - <br />Washington Slate Energy Code <br />Q Prescriptive Approach, <br />Chapter 6 <br />O Component Performance <br />Approach, Chapter 4 <br />O Systems Analysis, <br />Chapter 5 <br />COMPONENT <br />Flat Ceiling <br />Ft3. <br />Vaulted Ceiling <br />R............ <br />Wall <br />R21u..A <br />Below Grade Wall: <br />interior <br />R............ <br />exterior <br />R. <br />Floor <br />Slab on Grade <br />R. (Q.. <br />Doors S Frame <br />U.1.r31. <br />Glazing <br />UA.......... <br />%Glazing <br />.�. !. <br />Solar Allowance <br />...........% <br />Air Leakage e-6-1D OADV <br />I hereby certify that the structural panels will meet the NWEC Fornaldehyoe requirements -either the <br />HUD standards or marked-extennf or 'exposure I! - a, <br />The local jurisdiction/electric utility will make a ppayment to either Me builder or owner tar neweimuw <br />healed residences. Permit must be issued by 17131/91 and construction finaled by Bl30A2 in order to <br />quality for payment. To facilitate payment, Me following infonnabon must W filled rout completely_ <br />_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br />Mail check to: (please print) (ADDITIONS/REMODELS NOT ELIGIBLE) <br />Name��dr�s,r..��.fll!.l.!3k.. Fed. Tax /ID orSSO... a 5....". ......:....�1rC..7........ <br />Address .... yuj........ uq./lAl/JP:.f....1.1,F�.0............................................................... <br />City.,'&.r...C,H....................... k A4.................................. Zip. .2.>L�........................ <br />NOTE: An IRS Fortn 1 D99 Will be sent at the end of Me )tar. <br />