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, '"`` Activity/Pi ;rit # <br />FORM INSTRUC710NS: <br />Please read befon completlnp form <br />FIII in all ahaded inlormation boxes that apply to your pro�ect. �0_ppt place marks in the two left side <br />columne Iabeied " COMPLIANCE RE�UIRED" and "INSPECTION APPROVED". Since this form <br />wili be evaluated tor completeness, you can avold unecessary permit delays by carefully providinQ all <br />required Information. You may disregard tMormatfon requestes that don't address your paAicular <br />buildirp or equipment. <br />S1aN members wlll help with general questions about filling out this form. However, it is your <br />reponsibility to provlde specific Information for heating systems, giazing, Insulation, and other <br />building speci(ications. For specitfc requirements, refer to the Northwest Enerpy Code, 1987 Edition. <br />Thfs form will uftfmateiy be the basfs (or all NWEC field inspections. You can avoid problems by <br />seekinp approval for any substitutions belore Incorporati:�g them into the project. The bulldinp oHicial <br />may require that you substantiate compliance claims about building products or techniques by <br />providing documentetion from approved testfnp agencies or code authorities such as IC80. <br />When your permit is issued, you will receive a copy oi this form. Boxes will be checked under <br />"COMPLIANCE REQUIRED^ Indicating NWEC requiremeMs that must be incorporated i�to this <br />pro(ect. Each chedced requirement will be evaluated by the building inspector and , when deemed <br />acceptable, marked approved in the "INSPECTION APPROVED" column. <br />DATE.r �-�� Clty EvE.YET f"' _County_.�iVoHcry� � s/f ' <br />NAME LyLr E. ,B/�,�� gU1LDtNG ADDRESSS�ia�,r�:7' /�v� l>� :a7.sf.�iLOT �I� <br />BUILDIN�YPE: <br />New <br />❑ Remodel <br />❑ Addition <br />COMPLIANCE PATH: <br />Resfdential: �Singte Fam. ❑ <br />❑ Multi Fam. � <br />❑ p StOries_ (s 3) ❑ <br />❑ <br />Neating System Type: <br />ElectriC: <br />[]Base board �Forced air furnace <br />OHeat pump [�Zcne heaters <br />�Other <br />NWEC plan rev/ew: (Department use only) <br />Approved by Date <br />Chapter 6 (< 5000 Ft2) <br />Component PeAormance Chp5 <br />Systems Analysis Ch# 4 <br />Pofnts System Ch#7 <br />NOTE: All non•elactr�cally heated <br />dwelllnpa must comply wlth the <br />1986 Washlnpton State Eneryy <br />Coda and other ordlnancea of thls <br />Jurt�dictlon. <br />WEES �PPIL YO <br />Pepe 1 of 7 <br />