|
y n r+
<br />� C+7 �
<br />C�r�+
<br />a � v�
<br />H ��
<br />K y�
<br />'�rJ y �
<br />tT7 O �
<br />Q H
<br />n �g
<br />r y�
<br />g °' y
<br />C� C7l�n
<br />� � Cr-7
<br />HON
<br />I
<br />�r.ir .;�� � : ' � � .
<br />!„pllwtionlPermd/ . ... ._t_.._ ..__.._.
<br />Owncr.�;aG,��%S< �� l\ �L�`l�.l.._ ..
<br />SiteAddressL.�t.}�.1_C, .....,._. __..
<br />Asscssor's Property T1x,Account No.
<br />'PUU PI.AM1 RIVfI:W N �� � ,-�� �
<br />.
<br />• /} c
<br />- ["�, EN G D[. "� -�
<br />y ->
<br />-�. 9 W 9 I 5[ N 1 S I f! 4 l i � I. �.
<br />, Si�cAddres:....... �. ......./ � ......... ... . ......._ ......... ........_........ . .................
<br />Owner'sAddress .........—...l.�..j........ ./...................-.{.�.........................:..: City..... .............................. 2ip .................... Phone ...................................
<br />Builder .���iL. � �:.....1.!..�.....L..S..l.�.�:1......... Address .�.Lj.r.`.-.�...I...� .................... ....................................................................
<br />City................................................................................................. Zip .................................... Phone ................................................................
<br />.
<br />.
<br />.
<br />.
<br />F.
<br />PhOJECT 11ESCFIPTWN:
<br />O New
<br />O Remodcl
<br />FUEL SOI1qCE:
<br />O Electric
<br />O Oii
<br />O Gas
<br />O Addition
<br />Cv-C�nditianed Sp R. _1.�..�.��'.�. �
<br />HEATIHG SYSTEM TYPE:
<br />C� 4}�s c botrd
<br />C� Ylali hratei
<br />p FwnaceAFUF .
<br />..................
<br />��binple Famiy / ol Stories....l ....:...........
<br />O hluhi�Famiy / ol Units .........................
<br />0 He�t pumD HSPF .._.....__..........._....
<br />OQiher_._._ ............._.............
<br />O Total inse,lied watls or BTU's ...___...
<br />_ ..-.,., �.,,..._...,.,�_.�,.-.,...,-..�,�..,.,-,.,...-z,,.,�..�.�
<br />...............................
<br />Check one e� the Lom�hance Opnon Br„e: �elcw In;eq ;".r �,a��.ir; min 1: ��,.,.., �• J;cbic e;c�;.6�i�r� ^��;
<br />sedion ml^r lo Ihe ir.strudmns nn t;ac1 ot lorm
<br />Electric � NarlhwE:t Enerqy Cade,
<br />Chopter6
<br />Q Well Insulated Floor n Systems Ara;ss.
<br />Oplian Chaptcr 4
<br />Q Well Insulated Wall O Componcnt P^rtormancc,
<br />Op�ion Chapler 5
<br />O PassFle Solar Op�ion O C^mpcnent °oint System,
<br />O Hcil Pump Option Chapler 7
<br />I OR �EPAf1TMCHT USE ONLY:
<br />Amount el Paymem E._...._...__ ................... .
<br />Dale PcrmA Issued ....... .. .. ........ .........
<br />Daie PcrmA Finaled .........................................
<br />I hc.c6y certify Ihat Ihie dwellinp vraa 6uil; in
<br />compluncc wnh Ihc NWEC.
<br />... ........ ...._ ......... ...........................
<br />�pildlll� DIIKq� Of a11�ilONlC AQl�I
<br />...........
<br />p��e
<br />Olher f uol Sourca� -
<br />Wuhinqton Slale Enerqy Code
<br />r; Cirscriptrvv ADprnach,
<br />Chapir 6
<br />O Coinponent Pedormancc
<br />Approach. Chapter S
<br />O Systems Anaysis,
<br />Chapter 5
<br />CO�dPONENT � r�
<br />flatCcilinp R.�..1..
<br />Vaulted Ceilinp R......1....,
<br />14d11 R.�..%..:?"
<br />�clow Giauc N'aIC �
<br />inlerior F............
<br />c�nerior R............
<br />Floar F�i.�....
<br />Swb on Grade R............
<br />�oors 6 Fr�me U.!..,'�..`%/
<br />Glaiinp U...,...+....y
<br />'kGluinp ...%':Y��'b
<br />SotarAllowance ..........!/
<br />AirLca4apc �SID �A�V
<br />�.••...•...
<br />I hereby crtldy V���I thr s:mr.� rtal nmcl. vnll meel Uk �I'�YIC lennalr.ehrAc �r,uiremen� � eithei tlic
<br />IIUO simidaids or m�i/eA' �� �ennf o�'e+Do%ure 1'
<br />Owner or Aulhorirod Apenl:
<br />/i ..
<br />. , � . � � .! . ......... ............. .........
<br />. _..... .. . ._ ......
<br />GnnlAmn< ..._..,._..�. ._..._.. �praWm
<br />ilce In<�I junsAictionielrc.lir ulJily w.0 m��e o p�1+�enl lo eimer Ne �uiAei oi ovmer Im neweittlrca�N
<br />hralW �rsidenrls Crrmit musi Ae issued hy 17J71,91 and conslrucAon hn�IeA �y NJOAI m ordei Io
<br />pmhly le {vymenl To I�ulilate poYinent, tlrt lollow�np minrtn�tion musl �e I�Itrd aW canDletely.
<br />Mail check lo: (oirs.r pm il I\I�I � I�I I� C:' �, ' I'.I ' 1� il�l I.'; ';� ��I I I.1 � l I Itl.l�. l
<br />IJainr.:.l�._. ... ... ..c_:. r _�.t... Fed. Ta+� ID or SSI � . ; ; � ,
<br />,
<br />. �
<br />Addiess.__.: ,.._ t ! ';... . . �. �.... _ •�.r. �..1�..�. .... c'.i �._c,,.:1>.�Y } .:.............
<br />.-
<br />CAy.........i.I..t.i..l�..>.k..�..i � ............................................. Zip..,...i_. �..%.....:.. �..............
<br />�,,... �,.,�,.�......�,..:..�,., ...................,,
<br />
|