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^a�e____�..4_�1�.`�� _._......_._...__.._........ <br />' �PPlict::;on/Permit /._----....----....----.--.- _, <br />�\ .:.. :,., <br />------.._...._ <br />Owner _�P-� _,.__i��.� �''•. � a w n i <br />....."'_..""""""'...._.... , <br />SiteAddress.. �ii� _�2�.�'_�_�..�W._w� � � <br />�Assessor's Pro ert Tax Account No. `•�`� <br />-- -- --------P----Y--------__---=---- '�: <br />. <br />• <br />. <br />. <br />. <br />NTIA <br />— .;: <br />I' S �- _ <br />SAe Address ....5....... `.�......_5� ................�..5.� �G.�.� 3 <br />...................................................... ........................................................................ <br />Owner's�( dress..........:�1:�.r:,�,0 ............................................Ciry....................................Zip....................Phone................................... <br />Builder...l...::e:.�:$:......! :�?'—c� .................... Address.......:�m.Q. <br />........ . ...... ............................. ............................. ............................... <br />City <br />PNOJECT DESCpIPTION: <br />Q'New <br />O Remodel <br />�FU.�EL SOUflCE: <br />v tieclric <br />�ition <br />CY�onditioned Sq. FI...�.�a:... <br />HEAT!NG SYSTEM TYPE: <br />� O Baseboard <br />. O Oil O�t�all heater <br />• O Gas O FurnaceAFUE ................... <br />• <br />• <br />. <br />.••.•••...••••.•..••• <br />Zip <br />Phon. <br />�le �amiy <br />O Mufti-Famity <br />/ of Stories.......� ..:........... <br />/ of Units ......................... <br />O Heat pump H5PF .............................. <br />OOther ................................................. <br />O Total installed watts or BTU's ............ <br />....••..•.••....•.•.•...•.••.• <br />Check one ol ihe Compliance Oplic,� Boxes below. Insert the vaiues into box number 4. Befure complelinp Ihis <br />sectlon reler to ihe instrucfioason back ol farm. <br />Eleclric - Nor�hwest Energy Code, <br />Chapter 6 <br />� Well Insulated Floor O Sy,tems Analysis, <br />Option Chapter 4 <br />� Well Insuiated Wall �mponent Pedormanc , <br />Option Chapter 5 <br />O Passive Solar Option O Cempener.t Point System, <br />O Heat Pump Option Chapter 7 <br />=0H UEPApTMEHi USE ONLY: <br />lmourrt o1 Payment j.:.. ......:`.: .......: <br />)ate Permh Issued....:.( ......:.. ........:' <br />IeIP PPlmB CmInA . ., . <br />I hereby certily ihat thl <br />compliance wRti the N' <br />���� � Bmidlnp Otfiwl orAutho <br />......._ � ....... <br />D�te <br />� <br />'dwellinq ttias buifl in <br />lEC. <br />.. :........ ...:..... <br />ud Apent. � � <br />Other Fuel Sources - <br />Wa:hinglon Slale Enerqy Code <br />� Przscriptive Approach, <br />Chapter 6 <br />O Component Perlormance <br />P.pproach, Chapter 4 <br />p Systems Anaysis, <br />Chapter 5 <br />COMPONENT , <br />Flat Ceilinq R.,3.FL., <br />Vaulted Ceiling R............ <br />Wall Ra71..�t <br />Below Grade Wall: <br />interiar R............ <br />eMerior R............ <br />Floor R..�.G? <br />Slab on Grade R...1_�... <br />Doors � Frame UA.y.�.. <br />Glazinq U.,.H.�... <br />%Glazing (. °� <br />SolarAllowance /.7�% <br />AirLeakape (�'STD �ADV <br />••••..•.•• <br />I hereby certily ihal lhe slrucNal ponels will meel ihe NWEC FomiaWehyde repuiremenh • either ihe <br />HUD stondards or rnarked'exterinf or'ezposure 1' <br />Owner or Aothoriied Aqent: <br />..................................................................... . . ........................................................... <br />Print Nune SipnaWrz <br />The Ioal jurisdicUon/elecirk uoliry will m�Ke 3 paymenl to eitl�er Ne huilder or owner lor new electrically <br />hwted residenres. Permit must be iss�ed 6y 17J31N1 �M consinxAon fimkd hy W30H2 in ordet lo <br />pu�liy lor p�ymenl. To I�cilitate p�ymmt, tl�e lollowinp inlortmAon musl be filkd out compklely. <br />Mailthecklo:(p!easeprinp (qDDITIONS/RG�fODGLS NOT ELIGIBLE) <br />Name ................................................ fed. Tax ID or SSY.................. _.. <br />Address ............ <br />Zi p .......................................... <br />HoiF�. A, IFS Fan 1 W9 w,n M unt �t L�e ena ol Ine `ear. <br />