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' <br /> ��U hIC_.Z'�i� ...............................................Zip:��.�.�.i Z7:.'.�.........Phone..........'...�.�..._�I.�.�?.�...................... <br /> y � Ciry........f....:................................�. <br /> � o � • <br /> tid . , <br /> � � g ' <br /> . ���. '�' <br /> c�� � • <br /> H • ppOJECT OESCHiPTION: --� <br /> xa H � • �New O AdEition )2 � 18Single Famiy /of Stories....�,........... <br /> t-� y 7. ' <br /> y y � Q Remodel 6FConditioned Sq.Ft.--.:�.�...... �MuLi-Famity Y of Units.......�.............. <br /> FUEL SOUHCE: HEATING SYSTEM iYPE: � � <br /> � d y J8 Electric O Basehoard O Heat pump HSPF .............................. <br /> �� ti � O Oii Wall heater O Qlher................................................. <br /> x y y � Q ��5 � Furnace AFUE................... O Total installed watts or BTU's............ <br /> HO (n • <br /> . -ssn�c� <br /> • <br /> � • � � � � � � � � � � � � � � � � � � � • v • � � � � � � � � � � � � � � � � � � � � � � � � � � � � • � . <br /> iC6MPONENT � <br /> I �� � � �� � Flat Ceilinp R...��..�• <br /> � Vaulted Ceiling R............ <br /> Check one of Ihe Compliance Optlon Bazes below.Insert the values inla boz number 4.Before complelin0��S yyall R�z�••�� <br /> � � seUion refer to Ihe instmcdo�on 6xk oi fartn. x,�, <br /> Below Grade Wall: <br /> Eieefric•Norlhwesl Enerqy Code, Olher Fual Sourees- interior R............ <br /> �� <br /> Chaplar 6 Wa�hinqton State Enerqy Code ¢�erior R............ <br /> Q Well Insulated Floor O Systems Anatysis, O Prescriptive Approach, Floar R.3.� <br /> � ��� Option Chapter4 Chapter6 i <br /> SWb an Grade R.......... <br /> p Well Insulated Wall �2 Component Pedormance, O ComponeN Pedormance Doors&Frame U.��=..�� <br /> Option Ghapter 5 Approach,Chapter4 <br /> �+ Glazinq U...�'.�..� <br /> � Q Passive Solar Option O Cempener.t Point System, O Systems Anatysis, °/,Gluing 1G�.:�.9a <br /> I �1� O Heat Pump Option Chapter 7 Chapter 5 SolarAllowance ° <br /> .........../e <br /> AirLeakage �STD OADV � <br /> • <br /> �_ o . . . . . . . . . . <br /> __ <br /> FOti OEPARTMENT USE ONLY: � � � � � ' � � � � <br /> � � <br /> �1�� Amount ot Payment 5...................................... I herehy ceniy ihat Ue structural paneLs will meet�he NWEC FarmaWehyde requirements•eithar ihe <br /> HUD standards or marked'extedof or'exposure 1' , <br /> Owner or Authoriied Apent: � <br /> DatePermRlssued............................. .�/.1.��'.2...�?: �u.�..�?.�� ................................................................. <br /> ..... .............. . . <br /> � -� PdntName � SipnaWre <br /> DatePe�milfina�ed......................................... Thelofaljurisdic6oNelectricu6lirywilimaKea paymenttoeitherthehuiWerorovmerfornewelxtriwly <br /> � healed resulences.Permit musl he issued hy 1?131H1 and canst�ucAon finaled by fi�30F12 in order to <br /> qwliy for paYment.To facililate paymrnt_Ne followinp iniortna6on must 6e filkd out complelely_ _ <br /> Itiere6ycertitythatthisdwellinpwasbuiltin Maileheekto:(pleasepdnq (pDUITIONS/REMODGLS NOT ELIGIfi,{�E) <br /> compl'mncewdhtheNWEC. � ��33 ..'�.�j_ ,)��1 �j <br /> Namev.�C;TD(� ��GGZCc}Ped.Tax ID or SSY...................................................... <br /> ..................... <br /> .................._............................................_........... � -C' <br /> BuildinpOflkularAutl�orizedApent Address....I.c�_�'..z�-..._�.d..�..�....�tJ.........��:.................................................. <br /> J1+��l?c�Tc �; ................... z�P......`��.zz�............. <br /> ....................................................._._._........ <br /> .......... c�............:........... ... . ...................... <br /> Oate <br /> NOTE:M INS Fortn 1099 x+i�M xnl at Ne end o1 Ne yaar. <br />