Laserfiche WebLink
�,nDate.�`►�' 91 _ <br />S.,f . -` <br />-�+ ADpiiatio amd l • _ - <br />._ o,�,«._ I c�e�2� I a rv _ <br />Site ACdress ._ ,7���__�X_I.. M Q�[�._ <br />Assessor's Pro�erty Tar_�lccount_Mo. <br />�oi�n or.�u VC1fTCW vn r�[.G�...��• . <br />. <br />Site,tddress ....e .�Q.... �+.......W. � .I...{.l �_t1..K.C....�..l..._CC/.....,....�..,.........r- .................................................................... <br />Cwner'sACCrcss...�...!�'_�..I.......����.��� .............................Ct�.._!-iJ,E,,Q�C7...._ Zip ,cl,.�oi.Ul..Phane..2..:1a�...I�...w.�....�. <br />e��ieZ�..D.�a,� erc.,,.;.4_y��� .........................ae��.55...._5_3.y�-? ...13.���....�.UL..._$E................... <br />....... � .... ........................... <br />C�ry...�1J.Q.FW.m.IS�'I .......................................................Zio...:.1..9a�..1..�........... Phcne ��:.9342 <br />......................................... ...... <br />P90:E:T DESCAIPTICN: <br />� Vew <br />Q Re�oCei <br />FUt� SOUqL:: <br />i8 'cEc�r'c <br />C ,�Cditian <br />�t Ccnd3icne? Sa. F!. �_636.... . <br />HEAiING S'fSTc?d i (Pc: <br />O ?aszEwrd <br />; O Cil �1'Nall hc.[er <br />• � O GSS O F�f^SCL �iFL�: ................... <br />S9 S�nSle ramity <br />O NuNi•Famih� <br />/ af S;cres.��.l�........ <br />f of Urits ......................... <br />O ��,t au�,p � 5aF .............................. <br />OCther ................................................. <br />� ictalins�alledvva;isarBiU's............ <br />. <br />• _ �. � <br />. <br />.....• ............... ........•..•...••........�.... <br />- - �o� - --- <br />C`eck ore :t �e Came:i:.r.� Ccccr 3as�s Salc�. Iraart �e sJces inta Cax numCer J. Pxloa campietinp �is <br />szr.ian rcfer.o ]�e Ins;.vuonsan S:ckaCorrn. <br />Eiect:ie • 4arttiwes: ��xrqy Lad±, <br />Llaottr F <br />Q'Neil!nsulate:::ccr O Svs;a�s.Anaysis, <br />Ccticn C`zctzr � <br />�'Nzil!nsulaad'Nall �lCcnponent?erormance, <br />Cotian Chapter: <br />O�asa;v �cfar �aticn Q Cc.^.;c.^.^.^.r ?oir.t Sys;em, <br />G'�rat?umoCcrcn C��aptzri <br />FOR OEPARi11EVi UScONLY: <br />. �Ar�curt.olPaymeit5 ....:.... _..�,.....�.. <br />. Date 7=md ls;aeC ..._.:........_. . .... � � .:._ �. <br />1 Data °e�mh Fnaled ......::= ....i.;:.:r <br />I Aere6y certity that thie dwellinq was huifl in ' <br />- �compliance •xrth �Ae Y5'lEC. � � � � <br />: .::::..:._.....:_ ..:......:...:.:....::...:......:.........._........... <br />.� BuiMir.QLYfcalorAuNod,eO?�mt _ � <br />. ........ ......:.: _.....:� .:......... <br />m� <br />Ofher Fuel Sourcec - <br />W�chinq�on State Enerqy Cade <br />Q Presc: ipGve ,lpproach, <br />Chaptar 6 <br />Q Cempcnert ?eAormance <br />ADFrcach,Chapter 4 <br />Q Sys;ems Anaysis, <br />Claptzr 5 <br />LOMPONEY7 <br />FtatCzilinq Ry9...... <br />Vaulted Ceilinq R............ <br />Wall ii21...feY.1 <br />Bx!cw GraCe Wall: <br />imerior A.11....... <br />ezzrcr R.......... <br />Fiocr A:�°�O <br />Slab an GrCe R.! o.. . <br />Dcars S Fr�re U.tZ2rr(9 <br />Gluinq U,:;�l.:.�/� <br />;r,Gluinq I7 s ;+; <br />SalarAllo•�nca .........."e <br />AirLwk�qe Blsio Oa0'/ <br />• <br />.••.•...• <br />I hereby utlih/ tluI Ihe slmcNril D���S x+ll meel tAe NWEC Farmaldehyde rtquiremen6 - eiNer the <br />HUO st�ndads ormided'uterinf or'erpaure 1' . <br />Owner or Aulfiorited Aqent: <br />..................................................................... ................................................................... <br />Prinl 4vne Sipn�Wre <br />fie laal jurisdktlon/elxlrk uGliry will m�ke �p+ymenl lo eitAer Ne buiider or owner lor new clectri�lly <br />h�led residenus. Permil must Ge asued by 1T/31Ni ud eonslruceon finiled by 6/30N2 in order to <br />awliy lor p�ymrnl. To I�cili�le p�ymen� Ne lalloxinp inlortmCon musl be fiikd oul eomplelely. <br />M�ilthetklo:(pk�sevrinl) (ADDITIONS/RE�fODCLS NOT ELIGIBLE) <br />Name............................................... Fed. Tax ID or SS/..................................................... <br />Address................................................................................................................................. <br />City ........................................................................................ <br />�L'_ <br />;•� <br />