Laserfiche WebLink
Dale --- — ----- 2-1- LL------ - - .. <br />Applicadun/Permit!»-------- -- tj CT <br />Cwncr <br />She Address ���! ------ <br />Assessor's Property-_T_ax_Account No. <br />A,9/-nyn3 - <br />0 W R I S E R E S 1 0 E N T I <br />►�i <br />SiteAddress ..... s v.. ..... in..7......... ...................................... ,................................................................. <br />City...... ............................. <br />Owner's Addresc.........��...,... .. � Zip .................... on ............................ <br />i� ,00 aT Ginsxr. v oe10 J ✓ _, <br />Builder_ S �o:........N,S.r........Address... ........................................ <br />A............................ .. <br />q a?.rl.a Phone .................K9.11 ......................... <br />JTR^?..V?v�a.................. ...............................Zip.....•% . <br />City ....................... ...... _ . <br />PRO ECT DESCRIPTION: <br />New <br />Q Nemod^.I <br />O Addition <br />Conditioned Sq. Fl...� r.�...... <br />FUEL SOURCE: <br />ivernic <br />HEATING SYSTEM TYPE: <br />O B eboard <br />II h t <br />O Oil a ta or <br />. O Gas O Furnace AFUE................... <br />'43rS-ingle Family / of Stories ........ /......... <br />O Muhl -Family / cf Units ........................ <br />OHeat pump H:PF .............................. <br />OOther ................................................. <br />O Total installed watts or BTU's ............ <br />COMPONENT , <br />g... <br />EIIERGV conEGoriPLIANCEOPTIOUS <br />Flat Coiling <br />R.: <br />Check one of the Compliance option Boxes below. Insert the values Into box number 1. Before completing m¢ <br />Vaulted Ceiling <br />r Well <br />R^^•••g•• <br />Section tiler to the instructions on back of form. <br />Below Grade Wall: <br />i Code, <br />Electric - Northwest Energy <br />Other Fuel Sources - <br />Lode Washington State Energy <br />Interior <br />ex!eriot <br />R....^....... <br />R...'-... <br />chapter B <br />O Well Insulated Floor O Systems Analysis, <br />prescriptive Approach, <br />O D <br />Chapter 6 <br />Floor <br />R......0„ <br />Option Chapter 4 <br />Performance <br />Slab on Grade <br />R...... / <br />U <br />Q Well Insulated Wall Component Performance, <br />O Component <br />Approach, Chapter4 <br />Doors & Frame <br />/••a3 <br />U vly8 <br />Option Chapter <br />Glazing <br />j passive Solar Option O Component Point System. <br />O <br />O systems AnaWs. <br />Chapter 5 <br />%Glazing <br />••......• % <br />Chapter 7 <br />Solar Allowan a <br />...........'/ <br />s9•i O Hea: Pump Option <br />Air Leakage ASTD <br />OADV - <br />FolPaymell <br />USE ONLY: <br />l5..... .........................................ad................... .............. ..... <br />I hereby certify that this dwelling was built in <br />compliance with the NWEC. <br />........... .................... _........... <br />Buibinp Otlival or Audlomed Agent <br />............. .................... ._._...... _ <br />Dale <br />• <br />I hereby urlii Ni the structural panels will meet the NWEC Formaldehyde requirements - either the <br />HUD standar s or marked-extednr or'exposure 1.' <br />owner dr Aolhorized Agent: <br />......................................................... <br />Print Name p owner for new <br />hheaated neslidencer Permii must De will Make a <br />issued by iffimAI and either <br />ruuction hmkd by SMN2 in order to Ily <br />quality for <br />payment. To facilitate payment, the lollowm inform- mull be Blled out eompklely_ <br />Mail check to: (please Ddnl) (ADDITIONS/REMODE•LS NOT ELIGIBLE•) <br />Name................................................ Fed. Tax ID or SSI .................................. <br />Address ............ <br />Ct...................................... <br />' � <br />p.... <br />ry........................................................................................ _ <br />NOTE: M IRS Form I -'be sent U 01 end of It",. <br />