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Dale.----.. --2 :=cI/---------- <br />1EN <br />AppllcallolWcrmit /-__------___...---. _-- J � Ei CTY <br />DWnef._ DD�� atT. �N C� / IOWRIaE RES 10 ER <br />Site Address.__ �.L�$!�-__-�______-._. E <br />Assessor's Pru ert • Tax Account No._ <br />•PUD PLAN REVIEW NO <br />. She Address .............. #..... zy. .. V................................................................................................................. <br />Owner's Address......: C — C ZI ....... city .................................... p .................... Phone ................................... <br />Builder../..!.wS��!os G .....�4t.:.... N..S;-........Address... agO?......'Sf... .. oe e.il✓.1�........................................ <br />Ciy...........J� 14.�.t r!?aR.................................................... Zip ..... ./..ko�`1.a........... PhonItev5.-...4?. ......................... <br />PIECT OESCRIPPON: <br />New <br />O Remodel <br />FUEL SOURCE: <br />lVecfric <br />O Oil <br />O Gas <br />O Addition ''// <br />Conditioned Sq. FLIA..... <br />HEATING SYSTEM TYPE: <br />O B eboard <br />Wall heater <br />O Furnace AFUE................... <br />%�I maple Family 10 stories........! ............. <br />O Muhl -Family / of Units ......................... <br />O Heat pump HSPF .............................. <br />OOther ................................................. <br />O Total Installed watts or BTU's ............ <br />Check one or the Compliance Op lion Boxes below. Insert the values into box number 4. Before completing this <br />section refer to the instructions on back or form. <br />Electric • Northwest Energy Code, <br />Chaplet 6 <br />O Well Insulated Floor <br />O Systems Analysis, <br />Option <br />C 3pter4 <br />O Well Insulated Wall <br />Component Performance, <br />Option <br />Chapter 5 <br />O Passive Solar Option <br />O Component Point System, <br />O Heat Pump Option <br />Chapter 7 <br />FOR DEPARTMENT USE ONLY: <br />Amount of Payment S.......... <br />Date Permit Issued ......................................... <br />Date Permit Flnaled..........................:.:........n.. <br />1 hereby certify that this dwelling was b fn <br />compliance with the NWEC. <br />aviking OHktsl or Authorind Agent.. <br />Date <br />Other Fuel Sources <br />Washington Stale Energy Code <br />O Prescriptive Approach, <br />Chapter 6 <br />O Component Performance <br />Approach, Chapter 4 <br />O Systems Analysis, <br />Chapter 5 <br />COMPOhiNT <br />Flat Coiling <br />Vaulted Ceiling <br />R........:.. <br />Wall <br />Below Grade Wall: <br />interior <br />R... ...... <br />exterior <br />R... "... <br />Floor <br />Slab on Grade <br />Doors 6 Frame <br />R..- <br />....�fat3 <br />Glaring <br />U.1.7./.yS <br />%Glazing <br />.......... a% <br />SolarAllowan e <br />.........% <br />Air Leakage STO OADV <br />I hereby unify that the structural panels will meet the NIVEC Formaldehyde requirements • either the <br />HUD standards or marked'ex:ennr or *exposure 1.' <br />Owner or Authorized Agent: <br />...................................................................................................................................... <br />Print Name Signature <br />The local Iudsdlctionleleelrte ublily will make a ppayment 10 either the builder or owner for new electrically <br />healed residences. Permit must be issued by 12yJ1N1 and construction 6naled by 6MA12 in order to <br />quality for payment. To facilitate payment, the following iniormation must be Bikd out completely. <br />Mail check to: (please print) (ADDITIONS/REMODELS NOT ELIGIBtr) <br />Name - <br />Address <br />...... Fed. Tax ID or <br />Zip.......................................... <br />NOTT: An IRS Form ID99,na to unt at no end or N war. <br />