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Date __.. <br /> Application/Permitil <br /> LOWNISE AE310E NT UAL ` <br /> 1--4 Owner...._---------------------..___"._.-----.'__ <br /> rr a T y I i r r <br /> ty7 Site Address <br /> p�IS Assessor's r <br /> Proerty_TazAccount `::,; ;;•'•� <br /> ._ <br /> CZ aw •PJPLAN REVIEW Y :•.... <br /> �5 <br /> H3 • � , <br /> H <br /> KC] • Site Address ....:.....................................................................................................:.................................................................................n,........ <br /> HZ <br /> Ox O Owner's Address.............................................................................City....................................Zip....................Phone................................... <br /> Va <br /> Builder....-9 tI.7..../L�..h:l......_Ce^�iil!�r..Address....................................................................................../... ........................ <br /> O ... <br /> F3 • Zip....................................PhonA.....- . 3 <br /> C <br /> .... .................................... <br /> O H <br /> d <br /> n• n <br /> • <br /> z�„ '-3Z • PROJECT DESCRIPTION: <br /> H H miew O Addition �.A BS(ngle Family /of Stories............ <br /> N <br /> ty O Remodel O Conditioned Sq.Ft_....: ........... O Multi-Family /of Units......................... <br /> l7 to ® FUEL SOURCE: HEATING SYSTEM TYPE: <br /> &f1ectric O Baseboard O Heat pump HSPF .............................. <br /> • OOil p-Wall heater O Other..................... <br /> 0 to • O Gas O Furnace AFUE................... O Total installed watts or BTU's............ <br /> • <br /> ENERGY <br /> CODE a • 1• s COMPONENTIlene 0111111 qq <br /> Flat Ceiling R. .fl... <br /> Check one of the Complunu Option Boxes below.Insert the values into box number 4.Before completing this Vaulted Ceiling R............ <br /> section refer to the u,structons an back of form. Wall R. -.�... <br /> Below Grade Wall <br /> Electric-Northwest Energy Code, Other Fuel Sources- interior R............ <br /> Chapter 6 Washington Slate Energy Code <br /> D pp exterior R........,, <br /> O Well Insulated Floor <br /> O Systems Analysis, O Prescri trve Approach. Floor R.. LS <br /> Option Chapter 4 Chapter 6 <br /> ®/ Slab on Grade R........ <br /> O Well Insulated Wall Component Performance, O Component Performance Doors d Frame U.(.tf. .h8 <br /> ` Option Chapter' Approach,Chapter 4 <br /> g U.....V/ <br /> O Passive Solar Option O CempenacGlazin <br /> t Point System, O Systems Analysis,Chapter 7 Chapter 5 "•AGluinp 'b <br /> O Heat Pump Option "' <br /> ' Solar Allowance .....% <br /> _'•"� Air Leakage tL&D OADV <br /> • <br /> FOR DEPARTMENT USE ONLY: COMPLETE FOR ELECTRICALLY HEATED DINELLING4 r <br /> ........ I hereby cenity,out the slmciural panels well meet the NWEC Formaldehyde requirements•either the <br /> Amount of Payment 5...........e....._.......... <br /> HUD standards or reuiked'atennf it*exposure L' <br /> Owner atAulhorued en• <br /> Date Pe,mil Issued......................................... �L i2 Y(• e�t r VI/1 ..�..1�.' <br /> Pnnl Name Signabue <br /> Date Permit Finaled.......................... .............. The lout junsdectioNeIMIN:utility will make appayment to either the builder or owner for new electrically <br /> nealtd iesidenus.Permit must be issued by 17/31,91 and construction fimkd by 6130,92 in order to <br /> quality for payment.To facilitate payment,the following information must be fills out completely. <br /> I hereby certify that this dwelling was built in M3 (please spont <br /> compliance with the NWEC. I1 check to: ) (AUIII'fIoNS/RIJ101111s.5 NO 1`.1,IGIU1,F) <br /> ........'n-g ...._.........................A-a'in-f...................... <br /> Name._..................._._.....................Fad.Tax ID or SSI...................................................... <br /> Building ONKial nr Authodaed Agent Address.................. .. <br /> ....................................................._._..........—......... Chy........................................................................................ Zip.......................................... <br /> Date <br /> ----- NOTE.An iris ram 1099 w,a o,unt at me end it me yet,. <br />