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Date --- --- --------==--- <br />Application/Permit / ..—_---�------ ---- ----- <br />Owner <br />Assessor's Property Tax Account No; <br />THI-3 SET OF <br />DRAWINGS SHALL <br />BE ON JOB SITE <br />AT ALL TIMES. <br />SheAddress ZY h................... ..CY.lr........ G.T%d..f.(1.,.........%....2.n................................................... <br />a �Y...C. a<......... Ti Alf?/.. Phone .1,S.-11-..7..5' <br />.3I...1V1_2lh.,d..f......................cky..� : P.q........ <br />Owner's Address .. • •• <br />Builder.... 4,,e.r.7..£................. I.............................. Address ........ sA..xra.R........................................ ......... —... ........ ....... ......................... <br />City................................................................................................. Zip .................................... Phone................................................................ <br />77 <br />i <br />ws.��s.s.w•ww.•srs.� <br />PROJECT DESCRIPTION: &igIngle Family / of Stories.... ..vt......... <br />O New Q Addition / of Units ......................... <br />O Remodel O Conditioned Sq. Ft........... O Mufti -Family <br />=I <br />FU SOURCE: HEATING SYSTEM TYPE: <br />Electric ':) �seborrd O Heat pump HSPF .............................. ' <br />OOil (,)'Wall heater Q Other ................................................. <br />Q Gas Q Furnace AFUE................... O Total installed watts or BTU's ...7.5.4 0 <br />COMPONENT <br />LtIERGY CODE n • ' OPTIONS 4wCeiling R3 ••• <br />Vaulted Ceiling R••L• l •••• <br />Wall R1.1..... <br />seUioone n ro erfIhs la Db instructions�nbn back of foermw.lnsert the values Into box number 1. Delon completing <br />tkbw Grade Wall: <br />Electric • Northwest Energy Code, Other Wei Sources - interior R............ <br />Chapter 6 Washington State Energy Code exterior R............ <br />Q Well Insulated Floor O S stems Analysis, O prescriptive Approach, Floor p•^ <br />Option C pter 4 Chapter 6 Slab on Grade R.. <br />Component Performance D� & Frame U,�". <br />O Well Insulated Wall om ter 5 Performance, O Appr�h. Chapter 4 U. dq <br />Option Chapter 5 I Glazing <br />O Passive Solar Option O Componei Point System, O Ch tpter 5 Analysis, �•• %Glazing ��% <br />Chapter 7 Solar Allowance-- //...........% <br />O Heat Pump Option Air Leakage fJSTD OADV <br />F <br />DEPARTMENT USE ONLY: <br />um of Payment $. ••••^^ <br />Permit issued ............... _....... I ... ........... <br />..'s <br />Dale Permit Flnaled ..: •.••.••.. ••••••.•• <br />chereby <br />mp ianc lhic <br />dwelling was built in <br />... ..... ...... _.. <br />: <br />Buildinglding Official or Autlrorired Agent. <br />Date <br />I hereby entity tat the structural W tunets writ meet the MMEC Formal& qds rogUkemenb -either are <br />HUD standarsa or marked •exteder or "Posure 1. <br />Owniv orAu0lorized Agent: <br />.Prk...nl N.....a...m.e .................................. Sipnatun <br />The local jurisdictionklectFic utility will male a t to either au builder or owner for new ele dc* <br />heated resldenae. Permit must be Issued �y 1 tA1 and construction mated by snow in ender to <br />quality for payment. To While payment on_falowing nfo_mvdon_must be IS out ampIstuiy- — <br />Malleheekto:lpIsasepdnt) (ADDITIONS/REMODELS NOT ELIGIBLE) <br />Name................................................ Fed. Tax ID or SS# ............................................. <br />Address.................................................................................................................. . <br />City.................. Zip.......................................... <br />.................................................................... _ <br />