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HnH <br />��� <br />A�x <br />C H <br />�Hx� <br />HZH <br />k n <br />H� <br />oxo <br />�l H <br />�io� <br />H t7 <br />Hl'���70 <br />�Y (] <br />zyH� <br />t"y�2�' <br />g�y <br />f� t7 � <br />��� <br />HO(�i� <br />. 2,�, .. �f j <br />o�i� ...._�d .............._'..._._.......... <br />.APPlication/Permit / ............._....._..._ ..._ _.__.............-------._....._ <br />� Owner......✓..r��'�t..._.....���... S.S..:........._......_�y..� <br />, <br />Site Address _—`---._._..._...._._.......---_. <br />Assessor's Property_Ta <br />'PU <br />0 <br />. <br />. <br />. <br />. <br />PISE BESIDEHiIA <br />0 <br />I.AN Rf:VIGIV N0. �5J% �.O � �/ �"v''� <br />�. .__�__.�. : <br />Suc Addresss�!�!..:U...��...''....%..�...�C. J..�!..........,�..!�t?..%'..f.'...�..... �.�.........�%. 4�...V, ./_ ........................ <br />Owner'sAddress...�...:�.t....�J..�.X....s�:./..�..� ...............�..... Ciry...�_!/f.G.P..I.-I..�.Zip...�''�.SF�.t,�.G'Phone.�.�_`�....�.��.� <br />T�/ M r0 �; rPQ� �/` <br />Buildcr.tc.Tt>�..�.f�..Y.1�..%..f...✓..1:...�.1.'u/..1./.........Address..�J �...(.......`l.l.�..f,l..�..� ..................................................................... <br />City ....��:P..�}..:P.. �� ..................................................... Zip ...�.S�Z."Q.�........ Phone .....�.!', j...�...'-... :5.�.`.7...�.............. <br />PROJECT DESCRIPTION: <br />O New <br />Q'Remodel <br />fUE�,SOUflCE: <br />�leciric <br />ddilion L� <br />G Condi�ioned Sq. Ft.../✓.......... <br />HEATING SYSTEM TYPE: <br />O_ �B ebavd <br />� � O Oil C9'Wall heater . <br />. � Gas O FurnaceAFUE ................... <br />. <br />. . —^.�,'cc.�e..�:Mt:.s::.�.: <br />��� � �.� . <br />•�����.����.�.������• <br />��� <br />Single FamiP� 1 of Stories....../........... <br />O Multi�Famity 1 of Units . ...................... <br />O Hcal pump HSPF .............................. <br />OQlhcr ................................................. <br />O Total instailed watis or dTU':............ <br />•����������������������������• <br />Check one of Ne ComDliance ODlic, Boxes 6eiow. Insert Ihe values in�o �ox num6er 4. �clore complelinp Uiis <br />seciion reler lo lhe insiruc6cns an cack of form. <br />Eleciric • Harthwest Energy Code, <br />Chapler 6 <br />Q Well Insulated Floor O Systems Anatysis, <br />Option C�npler4 <br />Q 1"leil Insulated lVall dComponeni Pcrlormance, <br />Option . Chap�er S <br />O Passive Solar Option O:^mpener.t Poin� System, <br />O Heat Pump Option Chapter 7 <br />FOR OEPARTIdEHT USE aNLY: <br />Amount of Payment 5 ...................................... <br />�atc Permit Issued ........................................ <br />Date Perma Fnaled ......................................... <br />I hcre6y c^rt:ly Ihal Ihis dwcllinq v,zs buiY in <br />cemp�uncewuhihellP;EC. � <br />.................. _......................................................... <br />Duildinp 011icul orl�iNonted Apenl <br />Dalc <br />Olhar Fuol Saurces • <br />Washington Slale Enorgy Code <br />Q PreseriptNc Appraaeh, <br />Chapter 6 <br />O Component PeAormanee <br />Approach, Chapter 4 <br />O Systems Anatysis, <br />ChaD�er 5 <br />COMPONEHT . p <br />Flal C:iling R.30„ <br />Vaul:ed Cr.iling R........... <br />Wali R..2.�.. <br />Below Grade Wail: <br />intcrior R............ <br />e�erior R......q. .. <br />floor R...�...1... <br />Slab an Grade R............ <br />Daors 8 Frame U......" .— <br />Gluinp U.r'?�.�. <br />°/Gluing .�,a....% <br />SolarAllowance�� ........._% <br />AirLrakage C�ST� OADV <br />.......... <br />I here6y certity Nal Ltie slrucNral DaneLS will mee� �he NYlEC Faenaldehyde reQuiremenLs -eiNer Ne <br />HUDslandaidsormaiked'extenni or'ezposurel' . <br />Owner or�Aulhorized Agenl: <br />. ................................................................. <br />. ............................................................. �QnaWre <br />Pnnl Nanic <br />Thelaraljurisdicuon/etttlricutiliywiumake� paymentloeitherNe6uiideroravmerlornewelectriwly <br />healcd residences. Permil musl be usued by 11/31N1 and consWcuon finaled by N30A2 in order to <br />quality lor paYmenl. Ta lacdilale paymml, the lollav+inp Inlormauon mus� be Glled out complelely_ _ <br />Mailthetklo:(DleasePnn�) (pUU]"PIO\S/ItI:DIOUIiI.S NOl' CI,IGIt1I.1:) <br />�amc .. <br />AdGress ................. <br />Ciry ...................................... <br />Fed. Tu ID ar <br />Zip. <br />!:0"S' 0.� Iq5 f.rn iRq wn N•.•� •• t•.< md cl �r war. <br />