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U2320 California St., Everett, Washington 98201 258-8211 <br />Mailing Address: P. O. Box 1107, Everett, Washington 98206 <br />Snohomish PUD Reference ONLY <br />Energy Plan Review #:_ p5 -U/y,r <br />"NWEC" Plan Review and Compliance for Electric Heat Residences <br />Date:_ <br />Plan Check No: Q0/1-w"3 <br />Assessor's Property Tax Account No: <br />Jurisdiction Basic Plan #: <br />Builder: At- c. -L. ) F >T 71=uFc 0Pw+F^,f —, 1:;uc . <br />Address: /z3,S Morrlt SPDw� N Z <br />City: _(�yNivwocn Lc7A 9N037 <br />Phone: 3 S5 200� <br />Single Family: <br />Multi -Family: Buildings: Units: <br />Site Address: - ---15 X X T14-%Tµ -,T C <br />Compliance: Chapter 4-Systems Analysis_, Chapter 5-Component Performance <br />Chapter G-Prescriptive_, Chapter 7-Component Point <br />Note: See attached documentation for <br />energy <br />/requirements. <br />Snohomish County PUD #1 Representative: ��) H. G <br />nature <br />Sot n) ALAX& Z3$ -f 2-77 z— <br />Print Phone <br />*ITEMS BELOW ARE TO BE FILLED OUT BY THE APPLICANT* <br />---------------------------------------------------------------------------- <br />Builder / Consumer Payment <br />Owner or Authorized Agent:�� <br />Signature <br />Mail Check <br />NORTHWEST <br />ENERGY CODE <br />To: <br />Name: Mier- <br />Address: 'Z[ <br />City, St. <br />Tax Id.# or <br />Note: An IRS <br />C <br />rK <br />b8: -=. =)b-C <br />Form 1099 wil <br />AL PAF/_ 0 t j (oco7NLr,I <br />Print <br />Amount $ <br />at the end of the year. <br />C5'UO y�!<YenE,{brrp� <br />