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���' <br />ay <br />,m�x <br />�'..� H <br />ayv� <br />rx <br />Haa <br />yzH <br />r� o <br />H �1 <br />"�s� H °sJ <br />V1 H <br />�o� <br />H t7 <br />��g <br />YH� <br />4 <br />t yy <br />H <br />gd� <br />� � trl7 <br />HOti <br />�_, � '.�- 1 � � Activity/Permit # <br />FORM !NSTRUCTIONS: <br />Please read before completing form <br />��,a <br />Fill in all shaded informztion boxes that appry to your project. Do_n41 p�ace marks in the two leit side <br />�s columns labeled " COMPLIANCE REQUIRED" and "INSPECTION APPROVED". Since this (orm <br />� wiil be evaivated for completrness, you can avoid unecessary permit delays by carefuily providing alt <br />���� required information. You may disregard information requesles that don't address your particular <br />building or equipment. <br />�`� Staf( members will help with general questions about tilling out this form. However, it is your <br />reponsibility to provide specific iniormation lor heating systems, glazing, insulation, and other <br />building specifications. For specilic requirements, reler to lhe Northwest Energy Code, 1987 Edition. <br />' This form will ultimalely be the basis for all NWEC field inspections. You can avoid problems by <br />seeking approvai for any substitutions before incurporating them inlo the projecL The building official <br />may require that you subslanliale compliance claims about building producis or techniques by <br />',, providing documentation Irom approved testiny ac�encies or code authorities such as ICBO. <br />3 1 When your permil is issued, you will receive a copy of Ihis lorm. Boxes will be checked under <br />� "COMPUANC[ REQUIRED" indicating NWEC requirements that must be incorporated inlo this <br />projecL Each checked requirement will be evalualed by the building inspector and , when deemed <br />acceptable, marked approved in Ihe "INSPECTION APPROVED" column. <br />DATE � —`���City l�t,'ii�<`�i _County_ _Cnl_,I}�rt�`,l� <br />NAME �'� �����-�'`�'—` BUILDING ADDRESS `� � � -'1'�� ='�� `�' �� LOT #_ <br />BUILDING TYPE: COMPLIANCE PATH: <br />� New Residenlial: Sinc�le Fam. 0 Chapler 6(< 5000 Ft2) <br />❑ Remodel � Multi Fam. � Component Performance Ch#5 <br />❑ Addilion [� i� Stories_ (s 3) � � Syslems Analysis Ch?I 4 <br />� Foints Syslem ChN7 <br />Heating System Type: <br />....: ,.:: `/ <br />Eleciric: � <br />0 Base board orced air fumace <br />OHeat pump i. Zono heaters <br />D Other <br />���wrrY <br />NWEC plan revlew: (Depanmen� use oniy) <br />Approved by _Date_ <br />NOTE: All non-.�lectrically heated <br />dwellings must comply wlth the <br />1986 Washington State Energy <br />Code and ofher ordlnances ol thls <br />jurisdiction. <br />WEES APf11L YO <br />Page 1 ot 7 <br />