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mgQ H <br />rey � <br />'0x� <br />sea am, <br />col <br />Date 'l.�l v�11--------- <br />EPI Qµ <br />Application/Permit / <br />OwnerLDWRISE RE <br />She Address <br />Assessor's ProoertyTax Account No. <br />• v <br />SheAddress ...VA....q 1�!....5&.54................................................ »... _.................... ... _............................ ........... ............... „_..... ...... <br />Owner's Address ......................... <br />lI,j Builder ............ ............................................................. Aaarese..... <br />, City <br />• PROJECT DESCRIPTION: <br />O New <br />Addition <br />Remodel <br />fe Conditioned Sq. Ft. (gSS ...... <br />®O <br />FUEL SOURCE: <br />HEATING SYSTEM TYPE: <br />® Electric <br />O Baseboard <br />• <br />O Oil <br />Q Wall heater <br />O Gas <br />O Furnace AFUE................... <br />Zip ...... ........ »... Phone <br />Phone <br />® Single Family a of Stories.:..„,..„....... <br />O Multi -Family / of Units ......................... <br />O Heat pump HSPF .......... „...... „.......... <br />OOther .......... ...................................... <br />O Total Installed wars or BTU's ._........ <br />Check one of the Compliance Option Boxes below. Insert the values Into box number 4. Before completing this <br />section refer to the Instructions on back of tons. <br />Electric - Northwest Energy Cade, <br />Chapter <br />O Well Insulat^d Floor <br />O Syysstems Analysis, <br />Option <br />Chapter4 <br />O Well Insulated Wall <br />O 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 $ ..................................... <br />Date Permit Issued...„ ...................... ..... ....... <br />Date Permit Rnaled......................................... <br />I hereby certiry that this dwelling was built in <br />compliance with the NWEC. <br />........... I _..... _........................ I ......... .............. <br />Building Oflu:iat or Authorized Agent <br />Other Fuel Sources - <br />Washington Slate Energy Code <br />O Prescriptive Approach, <br />Chapter 6 <br />O Component Performance <br />Approach, Chapter 4 <br />OSysler +Analysis, <br />Chapter 5 <br />COMPONENT <br />Flat Ceiling <br />R.3Y..... <br />Vaulted Ceiling <br />R............ <br />Wall <br />RI.Y. P..W <br />Below Grade Wall: <br />Interior <br />A, ....... .. <br />exterior <br />R...»..... <br />Floor <br />R.1R.... <br />Slab on Grade <br />R.M/.A... <br />Doors d Frame <br />U .NIA... <br />Glazing <br />U..ahi.... <br />%Glazing <br />Solar Allowance <br />...........the <br />Air Leakage ®STD OADV <br />I hereby urtii that the structural panels will meet the NWEC Formaldehyde requirements -tither the <br />HUD standar s or mased'exlerfnf m'exposure ll <br />Owner or Authorized Agent: <br />kA..... ri'..1.. 5... <br />Print Name y ature <br />Name <br />e imise datip ent, the lo6_owinp infamue•n must be ttlked out completely <br />( like IsepdnI (ADD EI•JQDELS NOT ELIGIBLE) <br />Fed. Tax ID or <br />Address ......... _...;,.ac......................... .......... <br />_„...» __ ._»_ »................. .»... <br />Zip.......................... ........ _...... <br />• <br />