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gjjq <br />10 <br />U 000 <br />N <br />H <br />H <br />•i <br />Fit <br />rA <br />O to <br />ApplicallondPermit I I 2.66(� 4 .,... <br />•". L0 IN ISE RE <br />-Owner J_h_._��:� <br />LOT 2 SP IZ0Z-ro-cio <br />She Address <br />Assessor's Property Tax Account No. <br />a Z ,5/ ',- 2o2 6-91Q............................_...._........_.......................................................... <br />• She Address........7......................... i.............."................ . <br />Owner'eAddma.1...F...L.tC.k.Gr...1.L..<.:..:.,a:'t..R.R9MyCItY...C.Y.n..re.,.r.::..:::.:.. Zip .i.r.:.:.......#Phone..... .�i,';,;.•' (! <br />100. Builder eN — <br />4....F.i....(..�e: .....R(f..R'.L,R..S'..L'i4:' ...:.l... Address ........ ......'./..\!.'.i..(...........r�nJ.........:1.LiA^...5�'.:................................ <br />City............. .................................................................................... <br />• <br />• <br />PROJECT DESCRIPTION: <br />0 New <br />O Addition R <br />• <br />O Remodel <br />O Conditioned So. Ft ...........Y....... <br />©FUEL <br />SOURCE: <br />HEATING SYSTEM TYPE: <br />CaiEledric <br />O Baseboard <br />• <br />0011 <br />O Wall heater <br />O Gas <br />O Farnace AFUE ................. <br />• <br />Phone.......................................... _................ .... <br />Single family I of Stories... /....r........... <br />O Multi -Family I of Units ......................... <br />O Heat pump HSPF .............................. <br />0Other............. ................................�. o <br />O Total Installed watts or BTU's ..172::9 <br />Check one of the Compliance Option Boxes below. Insert the values into box number 4. Bs,ore competing Ihb <br />see'inn refer to the instruetinm t n back of Ionn. S <br />Electric - Nmftssl Energy Coda, <br />Chapter 6 <br />O Well Insulated Floor <br />O S tome Analysis, <br />Option <br />rapter 4 <br />O Well Insulated Wall <br />0 Component Performance, <br />Option <br />Chapter 5 <br />O Passive Solar Option <br />O component Point System, <br />O Heat Pump Option <br />FOR DEPARTMENT USE ONLY: <br />Amount of Payment $..................... ............... <br />Date Permit Issued .................................. <br />Date Permit Fin3led........... _......... .................. <br />I hereby certify that this dwelling wan built In <br />compliance with the NWEC. <br />....... ................. ............................_.....,.,... <br />6uilding DtkAal or Autlhodxd Apenl <br />....... <br />................ <br />.......... <br />.........__._...... _...... <br />Dale <br />Other Fuel Sources - <br />Washington Slits Energy Code <br />O ChaptePrescriptir fire Approach, <br />O Component Performance <br />Approach, Chapter 4 <br />O Systems analysis, <br />Chapter It <br />COMPONENT- <br />q <br />FL. <br />Flat Ceiling <br />�!/l <br />R.. <br />alfautted-Ceiling <br />67 <br />Wall <br />R...eZ.�. <br />Below Grade Wall: <br />interior <br />R............ <br />exterior <br />R........... <br />Floor <br />Ft.. • <br />Slab an Gn de <br />R...... <br />Doors & Flame <br />Grazing <br />U.• ..(., <br />%Glazing <br />I........% <br />Solar Allowance <br />............ % <br />Air Leakage �TD 0ADV <br />fin t the structural panels will meet the NWEC Formaldehyde requirements -either The <br />o marked•exterine Or•exposure i.' w s _L 1-2 <br />The local lodsdktienlelactrk: utility will make a payment to either Me builder or owner for new electrical? <br />hated residences. Permit must be issued ov 191AI and construction rmaled tv d30r92 in order to <br />panty for payment. To lacilitate pin men4. a following information must be filled out complil <br />Mail check to: (please print) (ADDITIONS/REMODELS NOT ELIGIBLE) <br />Name,f%l/JK.t*.....`..%(nR74.1yFed. Tax to or SS/...'t'?;V;� ..... <br />Address.Le.a/6.......1$'..N...P4.:.....W ..:......................................................... <br />City..... rP...M..C.N a ................................................. Zip...fAFD- ..'•—,.)....1...........I. <br />NOTE: An IRS Form iM VAN be unt at ins end at Ca year. <br />