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, <br /> ''3 C�� ` � � � 2320Calilornia St., Everett, W'ashingfon 98201 258-8211 <br /> p �'� � . � � Mailing Address: P. O. Box 1 f07, Everett, Washington 98206 <br /> c � <br /> 9 � y <br /> 4 <br /> snohomish PUD Reference ONLY r <br /> ''�y � Energy Plan Review #': f�,�-U/C�J <br /> '�U N '�9 <br /> NH <br /> � o�" ��NWEC�� Plan Review and Coapliance for Electric Heat Residences <br /> [n �+3 <br /> oHd Date: i�'- 3 � �c% <br /> � � g <br /> N� �CC Plan Check No: <br /> 9 y� Assessor's PropeYty Tax Account No: <br /> 1 <br /> �y H Jurisdiction Sasic Plan ; : _ <br /> H <br /> � d � 6uilder: /Y �U�ii�L c �-�nJ'r'f <br /> � t�� 1lddress: C� � V//LG�IN//{- <br /> z �7 v, city: � <br /> H o cn Phone: Z - - (cl <br /> � Single Family:�_ <br /> Multi-Family: _ 3uildings:_ Units: ___ <br /> � Site Address: __ij�j1�JI]Of'1 ��� <br /> T�� Compliance: Chapter 4-Systems Analysis_, Chapter 5-Component Performance x <br /> Chapter G-Frescriptive_, Chapter 7-Component Point <br /> Note: See attached documentation for eneryy requirements <br /> I �� Snohomish CoUnty PUD ',�,1 Representative: �� �• `^�!u— <br /> � $ignature <br /> Tvlh� /-�- L��I�F z� � -J7�z <br /> '�1 ' Print Phone <br /> � <br /> *ITEMS BELO{9 ARE TO BE FILLED OUT BY THE APPLICANT* <br /> ---------------------------------------------------------------------------- <br /> ��� <br /> Builder / Consumer Payment <br /> owner or Authorized Agent:_ <br /> ��� Signature Print <br /> Mail Check To: Amount $ <br /> r'ame• <br /> Address: <br /> City, St. : <br /> Tax Id.# or SS#: <br /> Note: An IRS Form 1099 will be sent at the end of the year. <br /> ��':•••:::::`1� <br /> NORTHWEST ��ppd� <br /> E N E RGY CODE �..��.T,�-;::e.,�,u„„�,� <br />