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FORM INSTRUCTIONS: <br />VAm6t— r-ACtiv1ty!^o4rmit # <br />Please read before completing form <br />FIII In all shaded Information boxes that apply to your project. Do not place marks In the two left side <br />columns labeled " COMPLIANCE REQUIRED" and "INSPECTION APPROVED". Since this form <br />will be evaluated for completeness, you can avoid unecessary permit delays by carefully providing all <br />required Information. You may disregard Information requester that don't address your particular <br />building or equipment. <br />2 Staff members will help with general questions about filling out this form. However, It is your <br />reponsibllity to provide specific Information for heating systems, glazing, insulation, and other <br />building specifications. For specific requirements, refer to the Northwest Energy Code, 1987 Edition. <br />This form will ultimately be the basis for all NWEC field inspections. You can avoid problems by <br />9 seeking approval for any substitutions before incorporating them into the project. The building official <br />l_ ti may require that you substantiate compliance claims about building products or techniques by <br />t providing documentation from approved testing agencies or code authorities such as ICBO. <br />N 3 When your permit Is Issued, you will receive a copy of this form. Boxes will be checked under <br />0- <br />0 "COMPLIANCE REQUIRED" indicating NWEC requirements that must be Incorporated Into this <br />project. Each checked requirement will be evaluated by the building Inspector and , when deemed <br />acceptable, marked approved in the "INSPECTION APPROVED" column. <br />7 <br />14 <br />Q <br />InF <br />/ City <br />F�Frcc n County <br />5nrc_--) on � shr <br />t- Ioc s7 D6vlrvr>.�UILDING <br />ADDRESS <br />Z 3XX -7q Sr. LOT N 3 <br />E L)F-ar 7r t✓A . <br />TYPE: <br />� COMPLIANCE <br />PATH: <br />JG <br />_YNew <br />r <br />Residential: 0 Single Fam. <br />❑ hapter 6 (< 5000 Ft2) <br />❑ Remodel <br />❑ Multi Fam. <br />t`� Component Performance Ch#5 <br />❑ Addition <br />❑ # Stories_ <br />(s 3) ❑ Systems Analysis Ch# 4 <br />❑ Points System Ch#7 <br />Heating System Type: <br />Electric: <br />❑ Base board ❑Fo 3dairfurnace <br />❑Heat pump ®Zor,, heaters <br />❑Other _, <br />NWEC plan review: (Dapanment use only) <br />`Approved by Date <br />NOTE: All non electrically heated <br />dwellings must comply with the <br />1986 Washington State Energy <br />Code and other ordinances of this <br />Jurisdiction. <br />WEE$ APRIL 00 <br />Page 1 of 7 <br />