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Date:�!''.�_I'1 �._ ............... ..._......._.
<br />Application/PermA / ..._._.------...-----------............
<br />Owner �
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<br />= '7 � t� S�t `, t. 1
<br />SiteAddress..... �_L. .. .,.�..�'._..._ '.� - � -
<br />Ass�ssor's Property T�x Accoun[ No.
<br />_ .. .......... .._ __....._..
<br />'PUD pI.AN Rf:VIEW N0. I ��"I �i�Cl(
<br />. �nirm�, �r�.r.r.s
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<br />IOWAISE NESIOFNTI
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<br />SiteAddress .........�. �(��yr�.,.,.�l.. � ................./................................................................... ........�......�..........................................................
<br />Ownei's Addrese ...u..`..:....i-�!�.1�..,.p.3 :3.�. Sc1 ...................... nCiy.......C.z..�..I................. Zip ....�Ll.l�%�. Phone ...................................
<br />Builder .......�_ S.L..... ,�.�iiY..�..1..,�.. ,...... Addreas .....I.:..�... .(.J-�...�.......3. ��..!F.?
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<br />,.�.....� ............................... .. . ...................... Zi � �.....3.. Phone................................................................
<br />Ciry ..................... p.............%...
<br />PHOJECT OESCNIPTION:
<br />6'New O AdEition mple Famiy
<br />Q Remodal G Conditioned SQ. FL .................... O MuAI•Famity
<br />/ al Stories .........:...........
<br />/ of Units .........................
<br />� FUEL SOUNCE: NFATINO uYSTEM TYPE:
<br />p'�lectric O Basehoard p Heat pump HSPF ..............................
<br />O Oii Q"Wall heater O Other .................................................
<br />O Gas O Furnace AFUE .................. O Total installed wans or BTU'e ............
<br />.�•••••�•�••..���•��C�����•�����������•�•.••��•••�••
<br />Cher.k one ol me Compli�nce Option Roxes Iblow. I�xert 7e vyuex into boK number 1. &lore complelinp U�is
<br />section roler lo the Insiructloro on bxk ol lorm.
<br />Eleclric - Norlhwest Enetqy Cod�, Oth�r Fuel Sources -
<br />Chaplar 6 W�shlnplon SI�I� Enerpy Cade
<br />p Well Insulated Floor Q Syeteme Anaynle, O Preecriptfae Approach,
<br />Optlan Chapter 4 Chapter 6
<br />O Well Inaulated Wall �mponent PeAormance, O Companenl Perlormance
<br />Option Chapter 5 Approach, Chapter 4
<br />O Passive Solar Option O C:mpener.t Paint System, O Systems Anaysis,
<br />O Heat Pump Optian ChaD�er 7 Chapter 5
<br />FOH DCPARTMENi USE ONLY:
<br />Amount o1 Payment 5 ......................................
<br />Daie Pcrmit leeued
<br />Date PermA Flnated .,......
<br />I her¢hy certily thal thie dw¢Ilinp wae buift in
<br />complianca weh Ihe NWEC.
<br />Beildlnp qf6ci�l or fwtl�odted Apenl
<br />. .... . ........ _....
<br />O,'E
<br />COMPONENT�
<br />Flat Ceilinq
<br />Vaulted Ceilinp
<br />Wall
<br />Below Gnde Wall:
<br />interior
<br />e�lerior
<br />R............
<br />R............
<br />Floar R..�.�..Q..
<br />Slab on Grade R............
<br />poore d Frame U�,:?�.:f
<br />Gluinp U,.37 �.`
<br />'kGluinp �:�.�.!ro
<br />SolarAllowance ..........!�
<br />AirLeakape OSfD OADV
<br />•••••••••
<br />I hercby urtily Ifut ihe swUurv panels � II meet the NWEC Form�idehyda re0uiremenh - ailhei Ne
<br />HUD slondards or nurked 'e.kdnf or'ex, vsure 1'
<br />Orner or Authorl�ed Apenl: � I
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<br />Prinl Nune Sipra�dm •
<br />The lo�l �urisdktlon/electrk u61iy will ma�r. paymcnl lo either the builder or ovmer Inr new elxlrkally
<br />heoted nsidanras. Pormit must be issued by L3�A1 ud conslrucAon finaled Ey N30A2 in aNer Po
<br />amliry 1or p�yment. Ta 1�cili�te payment, tl�e iallovnnp inlmm�6on must be Glled out canpbtely.
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<br />Moliehetklo:(pkasIepdnq (qDUl7'IONS/RI;P�IODf:1.5 'Jo7� III,IGIBIJ!)
<br />Name �::.:.: '�,, �:�...1.1......' ....:......:..... Fed. Tax I D or SS/.....::.::..:.....:.,.. ...:�. `.. t..l..............
<br />Addreee ...:.::.:.:..........:.:.._...,..:?........... �:,i::...:.........
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<br />Ciry.../,.. �....,.:..... � . :.............! .. �..: '......... .................
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