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D�'—Q �'L''�-- - Activity/Permit # <br />FORM INSTRUCTIONS: <br />Plaase read before completlnp form <br />FIII in all shaded Information boxes that apply to your proJect. �a.nGt place marks In the two left side <br />columns labeled " COMPLIANCE RE�UIRED" and "INSPECTION APPROVED". Since this form <br />will be evaluated for completeness, you can avoid unecessary permft delays by carefully providing all <br />required Information. You may disregard IMormatbn requestes that don't address your part�ular <br />buildinp or equipmeM. <br />2 Stafl members will help wNh general questions about filling out this form. However, it is your <br />reponsibility to provide specHlc Information for heating systems, glazing, insulation, and other <br />buildinp speciflcations. For specitic requirements, refer to the Northwest Energy Code, 1987 Edition. <br />This form will uftimately be the basis for all NWEC field inspections. You can avoid problems by <br />seekinp approval tor any substRutions before incorporating them into the project. The building oHicial <br />may require that you substamlate compliance claims about building products or techniques by <br />providing documentation irom approved testing agencles or code authorities such as ICBO. <br />When your permit is issued, you will receive a copy of this form. Boxes will be checked under <br />"COMPLIANCE REQUIRED" ind(cating NWEC requirements that must be incorporated into this <br />proJect. Each checked requirement will be evaluated by the buildfng inspector and , when deemed <br />acceptable, marked approved in the "INSPECTION APPROVED" column. <br />DATE �''��/`/'"i� Clt <br />r. <br />NAME I�ItIGX KI'�N✓� �UILDING ADDRESS �����'� ���/ �� � 1�'LOT q_ <br />BUILDING TYPE: <br />❑ New <br />❑ emodel <br />� Addition <br />Residential: I�SJ <br />a <br />Heating System Type: <br />Elec;ric: <br />[] Base board <br />�Heat pump <br />�]Other_ <br />[�Forced afr furnace <br />[�Zone heaters <br />� <br />NWEC p/an revlew: <br />Approved by <br />COMPLIANCE PATH: <br />Single Fam. � Chapter 6(< 5000 Ft2) <br />Mu1t1 Fam. Component Performance Ch#5 <br /># Stories_ (s 3) 3ystems Analysis Ch# 4 <br />� Points System Ch#7 <br />use <br />Date <br />NOTE: A11 non-e/ectrlcally heated <br />dwelllnys muat comply wlfh the <br />1986 Washington State Enerpy <br />Coda end other ordlnancea ol thls <br />jurttdktlon. <br />WEEB APPIL i0 <br />Page 1 of 7 <br />