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I <br /> I <br /> ; <br /> ��� <br /> . . <br /> � � � 2�?GCalil�'r i if . Ev('rrfl, Washrnafnr ur;.,�,. ;'�.,� �,�' , <br /> � ' Ivlaihng Ad�� _ P. 0 �ox ] l0i (�r��,,,1 V�' ,��, ,. ,�t� ., `�,4;' <br /> ��� <br /> q i-xi ' ■� Snohomish PUD Refer.ence ONLY <br /> �nergy Plan Review k : �"� �" ` � <br /> H �h�-i <br /> �H � <br /> O M O� ��NWEC�� Pl�n Roview and Compliance for Electric Heat Residences <br /> z Date: ��6 �9C- <br /> ��-yi � Plan Check No• _ <br /> � �g Assessor's Property Tax Accour.t P:o: ____ — <br /> �M� Jurisdiction [3n,ic Ylan k :____ <br /> H . <br /> �HH 6uilder: ��r� �i� �-iH�S�Yr.tt� - <br /> y ri Address: 21 S � � � �' �'� S F <br /> �y city: ����•P Lti : 1eS <br /> '�" Phone: 3SS c >er • E•S7 - ` 5ti1 <br /> � ' :;inqle F'amily:�'_ <br /> � 4'ulti-Family: _ Buildings:_ Units:_—� c' �, — 1 1 (}Y�' � � � L=_ <br /> Site Address: � \�k'�-^"'�'��' � � ' <br /> � — <br /> Compliance: Chapter 4-Systems Analysis_, Caapter 5-Component Performancr i <br /> � �� Chapter G-Prescriptive_, Chapter 7-Component Point__ <br /> Note: See attached documentation for energy requ/�y, rements. <br /> Snoho�ish County PUD #1 it�presrntativc: �� I����' �/ ���" �- <br /> Si nature � _ t� ; , � , <br />� 7�:�1� �I� ��ItE � 5 <br /> � �� <br /> Print Phone <br />� �� *ITEMS 6EIAW ARE TO b6 F7LLED OUT RY TtIP AnPLICAN'1'* <br />�I <br /> ----------------------------- <br /> ----------------------------------------------- <br /> '�1� Duilder / Consumer Payment <br /> I ownar or Authorized Agent:__ -- ---- Print <br /> Siqnature <br /> ��1 Mail Check 'Po: Amount $ __ <br /> Name• — <br /> Addres�• — <br /> City, St <br /> Tax Id. � or SSp : <br /> Note: An IR5 Form 1099 will be sent at the end of the ycar. <br /> N O R� ��i00d ,:C?tlts <br /> E N E RGY C��DE ,�.". ;�:�;., '`.,.>: <br />