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Activity/P�mit � <br />FORM INSTRUCTIONS: <br />Pls�i� rsed befnr� compl�tina form <br />Fill In all ehaded Informatlon bozes lhat apply to your proJect. �n.nct ptece marks In the Iwo lett side <br />coiumne lebeled' COMPLIANCE REQUIRED' end 'INSPECTION APFROVED'. Since lhis form <br />will be evalueted lor completeneea, you can evold uneceseary permit delaya by carefulty providing all <br />requirod Inlormatlon. You may Gisrepa►d Inlormatbn reques!ee that don't addrese your paA�ular <br />bullding or equlpmem. <br />Sleff inembers will help wlth general queslions about flllinp out thla lorm. However, R is your <br />reponalblllty to provlde specilic Information lor heating systeme, plazlnp, Inaulatlon, end o�►:ar <br />building specilicatlons. For specilic requirementc, refer to tho NoAhwesl Energy Coae, 1987 Editlo�. <br />Thls form wlll ultlmately be ihe basis lor all NWEC field Inspectlons. You can avold problems by <br />aeeking epproval for any subatitutlons belore Incor�aretlnp ihom Inlo the proJect. The bulldlnp ofliclal <br />may requlre thel you substaMiete compllance clalms about buildlnp products or techniques by <br />provldinp documentatlon Irom approved testinp apenciea or code euthorltlea such es IC80. <br />When your permil Is Iseued, you will recelve a copy of thie lorm. Bozes wlll be checked under <br />'COMPLIANCE RF�UIRED" Indicatlnp NWEC requiremerHe that muat be Incorporated Into thls <br />proJecl. Eech checked requlrement wlll be eveluated by the bullding Inspector and , when deemed <br />acceptable, merked approved in the "INSPECTION APPROVED" celumn. <br />DATt�'a'��=5'`tcCity � ✓ County �' � �' <br />NAME� ( G�'�� �' �� BUILDINO ADDRESS �l�- � IL''i ``��`I-SF LOT N_ <br />BUILDING TYPE: <br />❑ New <br />❑ Remodel <br />(� Additlon <br />COMPLIANCE PATH: <br />Realdenllal: Q�Sinple Fam. <br />�� Mulli Fam. <br />❑ M Sto:los_ (s 3) <br />Heatiny Systom Type: <br />Elecir�: <br />� Baee board <br />OHeat pump <br />DOlher_ <br />�Forced air lumace <br />�Zooe heaters <br />NWEC plen �evlew: (Depanment use only) <br />Approved by _Date <br />❑ Ch�pter 8 (< 6000 Ft2) <br />Component PoAormance ChM5 <br />Syetems Anelysis Chq 4 <br />� Polnte Syetem Chp7 <br />x,. : . <br />NOTE: All non•e/actrlc�lly ha�ted <br />dwslUnDi muaf comply wlfh the <br />1B8B Waihlnpton Sfefe Eneryy <br />Cod� end ofher ordlnence� ol thls <br />)urladlctlon. <br />WEE! �PRIL �0 <br />Pege 1 01 7 <br />