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Data — — <br />�.�--1 `� ---_L------------ <br />ADPlical'aNPamit / ------------------- <br />Ownu 5.1�._�_�C t�C1.Y_-------- <br />Sile Addreae �±.� � �.0�1114�_�� _�!� <br />Assessor's Pronertv Tax Account No. <br />• <br />• <br />• <br />• <br />• <br />• <br />� <br />Site Addreaa ...�..Y...l.1.....,.....SP!�?.^.f%.../.�!�...-.....frt�.J� .................................................................... `r............................ <br />Ovme�'s Addrass .....�!r.�{ .............................................. CMy.................................... Tip .................... Phone ................................... <br />BuiWer.�SiRf.':Sc.�'..���f�-��.... Addrese..�,O.Ge......�.�,e�-.f.'..•.J. .C.t.R.n....i.i�...-.�,.i1 ...................... <br />Ciy.................................................................................................Lp.................................... Phone................................................................ <br />PROJECT DESCRIPTION: <br />O Nnv ddition �Ole Famiy <br />O Remodel G Conditioned SQ. R . .................... O Muhi-Faniiy <br />/ 01 Stofies ..........:........... <br />/ of Unitc ......................... <br />' FUEL EOURCE: HFJITINC EYETEM TYPw: <br />Ci'E�ctric O Baseboard O Heat pump HSPF .............................. <br />� O Ol O�HMaII heater O Other ................................................. <br />• O Ga� O Fomace ARIE ................... O Tatal installed watte or BTU'e ............ <br />• <br />• <br />• <br />.�••���••.•....•.••••��������.•••••.•••.�•.•.•.••.... <br />Check one ot tlr Compi�na Optlon Baow bNow. Inwrt tlN vYues IMo boz numh�r I. Befan canpletiip Ihk <br />ceclfon nler to IM imtnctlar cn Gck oi form. <br />E�M�� `Nartlnr�tt EnM� Cod�, <br />Q �W�anwlrted Roor � Cli�pter4 ����� <br />p �W��nwlated Wall (�e6mponart Performanee, <br />h�pter 5 <br />O P�stbe Solar OpNon � CemponeM Paint S�stem, <br />O Heet Pump Optbn Ch�pter 1 <br />FOR DEPANTMEMT USE ONLY: <br />Amoum of PrymeM i.....:....» .....:......:......:...... <br />Date Pemiit Rnakd ..........:.............:................ <br />I here�y certilythat thh dwetlinp waa Euilt in <br />canplianca wAh the N1NEC. <br />........._......._......._ .........................._......._........... <br />Buildinp Olfici�l a Authori:eE Apent <br />.....................................................�.....__......... <br />D�te <br />Mhx FrN taorat - <br />w.�eam m„. �n.m ca. <br />O ��epts � ADProuh, <br />p ComponeM PeAormance <br />Approxh, Clupler 4 <br />O Syeteme An�lyeie, <br />Chapter S <br />COMPONENT - <br />FWt Ceiliop R..�....� <br />V�uRed Cr.linp R...... .... <br />Wall R�..�... <br />Below Gnde Wall: <br />interior R............ <br />e�Aerar R............ <br />Fbor R.w� Q. <br />Slab on Grade R......... . <br />Doon 6 Fome Ux�.�, <br />Gluinp U�...Y.7 <br />%Glozinp ...i. V.% <br />SoyrAlbvnnee ...........% <br />Afr Leakape O�lfQ OAOV <br />•��•••�•�• <br />I MnDy arL'1y INt M stn¢Nr�l Wnb wil meel Ihe NYVEC Fomulaehyde nWim�wnb • utlrr M <br />HUD �taMua� or raike6 ixterbf or �upaun 1' <br />Ownr or7�61f�a1n1 Ao�M: <br />PrintNiine..................................................... �iWre..................................................... <br />The lonl w�iedictlaNelectrie uHiry wil muu � t to eilher IM builder or owmr lor new �trinA <br />Ae�ted nsid�non. MrmH must G bwedby 1 tA1 uid comtnctlon M�led Ov 6�OAl'n oid�r to <br />pmfiy la p�yment. To hdlinY p�yment, IfM Idowinp infomutlon mua M BMd oul eompNWy. <br />M�ilehKkto:(D�D���) (ADDITIONS/REDfODELS NOT ELIGIBLE) <br />Name .,. <br />Addreee <br />Fad. Taz ID or <br />Noh: M ias �o� �000�w� e. rm um� Ma a ar �r. <br />