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�3 ![-J� H <br />� [a+l � <br />077x <br />C H <br />�H�n <br />y�i-�i <br />�H� <br />Ox0 <br />�NF�-i <br />��� <br />o i-+ <br />��8 <br />(�]Y (] <br />H <br />. �+ <br />H <br />�y f+ y <br />Oy <br />H <br />n �■ N <br />th1� t'� <br />�=1 <br />HOtyi� <br />� <br />L+ <br />� <br />__ <br />� � <br />�1 � <br />- � , , ActivitylF mit # <br />FORM INSTRUCTIONS: <br />Pleeee reed baforo completlnq lorrr� <br />� FIII In all ehaded Intorma0on boxes thet epply to your pro�ect. QLnol place mer�e In the Iwo lefl side <br />columna labeled' COMPLIANCE REQUIRED' end 'INSPECTION APPROVED'. Since this lorm <br />will be eveluated lor completenese, you can avoid uneceesery permlt delays by carelully providing all <br />required Inlormation. You may dieregard Inlarmetbn requeetes that don't addreas your peAicular <br />Dullding or equlpmenl. <br />Slal1 members will help wlth peneral questions about Illlinp out this lorm. However, it is your <br />reponslbillty lo provlde apeclfic Inlormalion for heatlnp systems, glazing, insulatlon, arai other <br />building specifications. �or specillc requlremenls, refer to Ihe Northwest Enerpy Code, 1987 Edition <br />This torm wlll ultlmately be the basls tor ail NWEC Ileld Inepeclions. You can evoid problems hy <br />snokinp epprovel lor any eubatitutlone belore Incorporating them Into the projea. The building o�t�c �;ii <br />m=iy requlre th�t you substantlale compiiance cleims aboul bulldinp producls or techniques by <br />providing documentation Irom approved testing agenclec or code authoritles such as iC80. <br />When yuur permit le Issued, you will receive a copy ol this lorm. �ozes will be checked under <br />COMPLIANCE REOUtRED" Indicating NWEC iequlremenls that musl be Incorporated Into this <br />projecl. Each checked requlremenl will bc evalualnd by Ihe bullding Inspoclor and , when deamed <br />acceptable, metked epproved in Ihe "INSPFCTION APPHOVFD" column <br />DATE�L`_ <br />__ c:o���r__ <br />�' <br />NAME ���'� ` � ' ! 1�� BUILDINQ ADDRE3S__ � �___ � �LOT # <br />BUILDINO TVPE: ...{ COMPLIANCE PATH: <br />❑ New Residentlal�, � Sinple Fam, ❑ �-����P���� `� �� `�"'"' � �: � <br />Remodel Mulll Fem. ' Gumponr.id f'ert!��nianeo �.hn5 <br />� Addl�lon ❑ N Storles_ _(s J) Systems Analysis ChN A <br />� Polnts >ystem Chit7 <br />� � �T. �:�w, a�s�-< �an�nn,� <br />Heatinp System Type: <br />Electrlc: <br />�Baseboard ❑Forcedairfurnace <br />[]Heat pump (�Zone heatera <br />0 Other — <br />NWEC plan revlew: <br />Approved by____ <br />NOTE: All non•elnctrlcelly heated <br />dwelllnps muaf cnmply wlth fho <br />1886 Waehlnpton Sfate Enerpy <br />Cod� end other ordlnences ol fhls <br />�wbdlctloR <br />�""_ <br />U50 <br />Dafe _ — <br />wFes ernit o0 <br />Pepe 1 oi 7 <br />