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r <br />xC`i1 <br />�ay <br />.ozm <br />c H <br />ayy <br />.ye � o <br />H� <br />'il H �+O <br />H y C~' <br />�i o � <br />OHd <br />��8 <br />�. � <br />ay� <br />rHy <br />8 �' <br />c� t7 m <br />��� <br />H O ly/r <br />Activlty/Permit # <br />NWEC �owris� Residentlal Compliance Check Iist <br />Electrically heated dweliings <br />FORM INSTRUCTIONS: <br />3 storles, Zone 1, Western Weshington <br />'d'f�3.n :�l¢:t iHa if. )0.:.-.lJ �h,: - ?itl`.aP i �Y1 9.Tp.2,� , �.yti <br />4 <br />Pleasa reed belore compleling form�',a�^^= <br />FIII In all shaded Infonnallon boxas Ihal apply to your pro�ocl. Qattol placo marks In llie two loll slde <br />columns laboled " COMPLIANCE 17E�UIf1ED" and "INSP[CTION APPf10V[D". Slnco Ihls lorrn <br />wlll be ovalualod lor complatonoss, you can avold unocossary ponnll dalays by carolully providinp all <br />roqulrod Inlormallon. You may dlsroq�rd Inlom'allon raquoslos Ihal doii 1 addross your pmlicular <br />bulldlnp �r oqulpmonl. <br />Slall mombora wiil holp wllh gonoral quosllons aboul lllllnp oul Ihis lorm. Flowover, II Is your <br />reponslbilily to provlde spocillc Informallon lor hoaling systoms, plazin�, Insulallon, �nd olhor <br />bullding specillcations. For spocilic requlremonls, rolor to lho Noilhwost Enorqy Coda, 1907 Edillon. <br />This form wlll ullimaloly be Il�o �asls lor all NWEC Iiold Inspoclions. You can avoid probloms by <br />sooking approval for nny subslllulions bolora Incorporalin{� Iliom inlo Ilio pro�ocl. l lio bulldinp olliclal <br />may raquiro Ihal you subslanllalo compllanco cl�lms aboul bulldinp producls or tochnlquas by <br />providing documonlalion Irom npprovad losllnp apooclos or codo aulhodllos such as IC00. <br />When your permll Is Issuod, you will rocoivo a copy ol Ilds lorm. E3oxos will bo cliackod undor <br />"COMPLIANCE REQUIREb" Indlcaling NWEC raqulromonis thal musl bo Incorporalod inlo Ihis <br />pro�ect. Eech chockod roqulromanl wlll bo ovalualad by Uio buildinc� Inspoclor and , whmi decmad <br />acceplable, markod approvod In Iho "INSPEC110N Af'PROVED" column. <br />. . .. .._.._..... , ._..,._. � .:....... . ...... . . ....:.•:r: • �.:�;,aa; <br />DATE �� ` Clly � v. 'r- r Counly 'Sti1-�r\ �rr,liFl <br />NAME� � � �hel� ' �� BUILDING ADDRESS ��Ll.c:'CTMiII'P `�G7-�' LOT <br />� � i` �, <br />��� UUILDING TYPE: <br />�,�' ❑ New <br />- F� ❑ Remodel <br />- v.> <br />"�' �Additlon <br />�� <br />a <br />COMPLIA�ICE PATfI: <br />Rasidonllal: �Slnplo Fam. <br />❑ Mulll Fam. <br />❑ H Stotlos_ (s 3) <br />Heating System Type: <br />Eloclric: <br />�(13aso board <br />L]Iloal pump <br />�011ior_ <br />NWEC plan re <br />Approved by_ <br />[�Forcod air lurnnco <br />j�Zono lionlars <br />���,s.. <br />' ;! <br />t150 oil <br />Dafe <br />❑ Chnplor fi (< 5000 f-12) <br />[�] Compononl Perlormance ChpS <br />y.,, Systoms Analysis ChR A <br />� Polnls Syslom ChH7 <br />NOTE: All non•oloctrlceliy heated �, . <br />dwollings musf comply wllh the a' <br />1906 Wasliingbn Sfele EnerBY IP�? • <br />Code end othor ordlnnncea ol fbls ���� `a <br />Jml�dlcllon. _ „�15 r�, <br />weca nrm� �o <br />rage 1 ot 7 <br />