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H c0 D)le- <br /> --- <br /> A y Et7ERQYDE:{ q —� <br /> x AppliratfonlPermA/ <br /> �. H I"y_•1 i L P� \'. l OW N IS[ N ESIeE Nil1l <br /> W Owner <br /> I if <br /> Y She Address <br /> H Assessor's Property Tax Account No. B <br /> QMO •PUD PLAN EV . ` <br /> H H <br /> - - <br /> She Address...... ...,.,,...7..LCz.......$.'�:..,.....�.....,,�...................—:..s..t..:�.,:t.a...,....................................................................... <br /> U - <br /> 014 Owner's <br /> Address.....................,............,........................................City...................................Zip...................Phone.............................. <br /> oHtBuilderA.r444.b:tj......QQ....WUX..,.t.!.......Address............................................................... ................................................4...... <br /> ZH ; CIry.......................... ...................................................Zip....................................Phone................................................................ <br /> �i-3 <br /> H H <br /> En <br /> H • �. <br /> ntvva <br /> p Ei PROJECT DESCRIPTION: <br /> • © <br /> O New O Addition - SfnDle Family /of Stories...r................. <br /> q CA <br /> 1-3 o En • O Remodel O Condhioned Sq.Ft.�..�..t:i.....:.. O Muhi-Family y of Units......................... <br /> ©> FUEL SOURCE: HEATING SYSTEM TYPE: <br /> O Electric O Baseboard O Heat pump HSPF ...........................- <br /> OOil O Wall heater O Other..................4.4.....4..........4.........., <br /> • O Gas O Furnace AFUE................... O Total Installed watts or BTU's............ <br /> I <br /> �� 1: r <br /> r <br /> COMPONENT <br /> Flat Ceiling R........... <br /> Check one of the Compliance Option Boxes below.Insert the values into box number 4.Before complelinp this Vaulted Ceiling R. q <br /> section refer to the instmctionsnn back of form, Wall R.I,....b... <br /> Below Grade Wali: <br /> Electric-Northwest Energy Coda, Other Fuel Sources- interior R........... <br /> Chapter 6 Washington State Energy Code <br /> O Well Insulated Floor O Systems Analysis, O Prescriptive Approach, exterior R. <br /> Option Chapter 4 Chapter 6 Floor R.CrS.�`l <br /> Slab an Grade R....,,....I <br /> O Well Insulated Wall C omponent Performance, O Component Performance Doors 6 Frame <br /> ~' Option Chapter 5 Approach,Chapter 4 7 <br /> O Passive Solar Option O Component Point O System, Systems Analysis, Glazing U.t. .... <br /> Chapter? Y Chapter5 y %Glazing <br /> O Heat Pump Option Solar Allowance .....'A <br /> Alr Leakage (9911) OADV <br /> FOR DEPARTMENT USE ONLY: COMPLETE FOR ELECTRICALLY HEATED OWELLING4 ' <br /> NLY <br /> Amount of Payment$..........................._......... I hereby certify awl the structural panels will meet the NWEC Formaldehyde requirements-either the <br /> HND standards or rnarked'extennr'or'exposure 1 <br /> _ Owner or Authorized Agent: <br /> 1 Dale Permit Issued.................................... <br /> .................................................................. <br /> Print............................................................... Signature <br /> I Print Name <br /> Date Permit Floated......................_................. The loaf ludWkt,xJelxtric utility will make appaaymenl to either The builder or owner for new eleclricalty <br /> healed residences.Pemlil must be Issued b F INNA91 and construction fmaled b SM192 knorder to <br /> it <br /> I hereby certi that this dwelling was built in quality for payment:To facilitate payment me Ioeowing information_must be Blbd out completely_ <br /> compliance with the NWEC. hlallchecklo:(pleasepdnO (ADOITIONS/REMODELS NOT ELIGIBLE) <br /> Name................................................Fed.Tax ID or SS/.,.................................................... <br /> ..................I....._.....I..... <br /> Buildleg Official or Autlodred Agent Address...................................................._............................................................_........ <br /> 4444. <br /> ......_............._.............._............._....... Chy........................................................................................ Zip..................................... <br /> Date <br /> NOTE An IAS Fenn 1099 re tel NMI at she end Of eco war. <br /> y e <br />