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,Date.._. �L`� /`J-------------- <br />IMEAO, <br />ApplicationlPermit / <br />Ownei.�L L e W e l s I A F 5I <br />SieAddress —4oi__I—. <br />Assessor's_ Property_ Tax_ Account No. _ �• <br />------- — --- — <br />•Orin ni eN OFV TFW Nn <br />r'75��00 <br />• <br />• Site Address .... %T...... I........ ................................................................................................................... <br />Owner's Address .l2r.3.—)...MJ.MdIr..T.ieo...�F?.t':KI".X Chy.... /-/..V.A idX l).. ZIP ...'TAaD.,r? Phons ...�ta..;e7r.4XT/... <br />FUEL.�?P.'E6AMAddress........... _f2.^1.!',11r......../.'.l..�a........ f1H..Q.K.�....................................... <br />• <br />�I city ...............................................................................................Zip <br />Phone <br />• PR9JECrDESCRIPT104: <br />VW <br />O Remodel <br />®FUELSOURCE: <br />ertlectric <br />OOil <br />O Gas <br />O Addition <br />O Conditioned Sq. Ft..... <br />HEATING SYSTEM TYPE: <br />O Baseboard <br />Chr all heater <br />O Furnace AFUE................... <br />/3`23y <br />mgle Family I of Stories ........ <br />O Muhl -Family I of Units ......................... <br />O Heat pump HSPF .............................. <br />O Other ................................................. <br />O Total Installed watts or BTU's ...7 <br />............ <br />OPTIONS <br />COMPONENT <br />�..:.. <br />ENERGYerE COMPLIANCE <br />Flat Ceiling <br />R.. <br />Check one of the Compliance option Boxes below. Insert th! values into <br />box number 4. Before completing thi. ; <br />Vaulted Ceiling <br />R............ <br />ZJ••• <br />section refer to the instructions on <br />back of form. <br />° <br />Wall <br />R.. <br />Below Grade Wall: <br />Electric - Northwesl Energy Code, <br />Other Fuel Sources - <br />Washington Slate Energy Code <br />interior <br />R............ <br />Chapter 6 <br />O Well Insulated Floor <br />O Systems Anahsis, <br />O Prescriptive Approach, <br />exterior <br />Floor <br />R............ <br />R3.Q <br />Option <br />CJtapter 4 <br />Chapter 6 <br />O Component Performance <br />Slab on Grade <br />R.......,../. <br />O Well Insulated Wall <br />®/Component Performance, <br />Approach, Chapter 4 <br />Doors & Frame <br />U... <br />Option <br />Chapter 5 <br />Analysis. <br />Glazing <br />UAd. <br />O Passive Solar Option <br />O Component Point System, <br />O Systems <br />%Glazing <br />I.......% <br />O Heat Pump Option <br />Chapter 7 <br />Chapicr 5 <br />Solar Allowance ✓ ..........'h <br />STD OADV <br />Air L^akage l•7 <br />FOR DEPARTMENT USE ONLY: <br />Amount of Payment $ ...................................... <br />Date Permit Issued ......................................... <br />Da0 Permit Finaled......................................... <br />I hereby certify that this dwelling was buih in <br />compliance with the NWEC. <br />........... I.. _ ............................................ _........... <br />Building Official or Authorised Agent <br />Daie <br />I hereby certify that the structural panels will meet the NWEC Formaldehyde requirtmen Is -either the <br />HUD standards or marked'exterinf or 'exposure 1.' <br />0 r orAuthorl:edAgenC �y�/% <br />�1/ 00... �'�........ <br />Pnnt Name Signature <br />The local jurisdiction/electric; utility will make a ppayment to either the builder or owner for new eleclricaCy <br />heated residences. Permit must be issued by IM,191 and construction finaled by 6IDDF.. in order to <br />pualtty for payment. To facilitate payment, the following information_ must be fills out eomPkldY_ _ <br />Mail check to: (pleaseprint) (ADDITIONS/REMODELS NOT ELIGIBLE) <br />Fed. Tax ID or SS, ..;Za *:'•.B0,-y719,� ......... <br />Address.:r��.....lQ.wN.....vL:.......`.^.:...................................................... <br />Cty......Q.M...f?/.1Jli�................................................... Zip......% ............................. <br />NOTE: M IRS Form logg..I to unt at ne me of menu. <br />