Registration Form

Complete the registration form below to be placed on the notification list for when we announce our next program for both Tacoma and parts of Pierce County, as well as for Darrington in Snohomish County. We hope to have program details in early 2012.

 

Program Update 2010/11 program closed --All funds spent New applications will be saved in case we have a future program. Check back here for program updates.

NOTE:  If you have an e-mail address, we encourage you to enter it on your registration.  By providing your e-mail address, we will automatically e-mail you a copy of your application and notify you faster if you qualify for a future program.

 

 

 

 

First, we need some information about you.
(* indicates required field)

Household occupant(s)
* First name:
* Last name:
Are you renting this household? YesNo
Alternate contact (if applicable, such as landlord)
First name:
Last name:
Household address
* Street:
* City:	, WA
* When was the home built? 1989-newer1961-1988 1960-olderdo not know
* What is the approximate square footage of your home?
* For the next 2 fields, EITHER select the household ZIP code from the list of eligible ZIPs, OR enter the household ZIP code in the Ineligible ZIP box.
Eligible ZIPs:	Select... 98241 98354 98371 98372 98373 98374 98375 98387 98388 98402 98403 98404 98405 98406 98407 98408 98409 98416 98418 98421 98422 98424 98443 98444 98445 98446 98465 98466 98467 98498 98499
Ineligible ZIP:
Mailing address (if different from address above)
Street:
City/State:	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
ZIP:
Telephone/e-mail
* Primary phone:
Alternate phone:
E-mail:
Providing a current e-mail address allows us to e-mail you a confirmation copy of your application, respond to you faster to let you know if you qualify and, if so, e-mail your program materials so you don't have to wait for postal mail.
* How did you hear about the Wood Smoke Reduction Program?

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Next, we need to know about the type of
wood-burning stove or fireplace insert you have.
(all fields are required)

Is it a freestanding wood stove, with a stove pipe going up through the roof or out through a wall? Is it a fireplace insert, which is essentially a wood stove that sits inside the fireplace? Is it a traditional fireplace that does NOT have a wood-burning insert, but may or may not have glass doors? (not eligible for past program but may be in the future)

Estimated age of device, in years:

When was the device installed:

Does the device have a US EPA metal plate with a date on it (probably on the back of the wood stove or on top of the fireplace insert)? Yes, 1994 or before Yes, after 1994 No, there is no plate present or not known

Does the device have glass in the door? YesNo

What is your primary source of heat? Oil furnaceElectric heat pump Propane furnaceWood stove/insert Natural gas furnaceTraditional fireplace Electric furnaceOther Electric baseboards

What is your secondary source of heat? Oil furnaceElectric heat pump Propane furnaceWood stove/insert Natural gas furnaceTraditional fireplace Electric furnaceOther or none Electric baseboards

How many cords of wood (a cord measures 4 ft. x 4 ft. x 8 ft.) are burned in this device per year?

Do you have natural gas service to your home? YesNo

Who is your electricity provider? Puget Sound Energy (PSE) Tacoma Power Elmhurst Mutual Power & Light Parkland Light & Water Co. Other

Why are you considering changing from a wood-burning stove/insert to a new heating device? (select all that apply) Financial incentives being offered Concerned about air pollution Remodeling/want an updated look Health reasons Safety reasons Tired of wood stove cleaning and maintenance Tired of gathering, stacking wood Other (describe below)

What would keep you from completing the change out of your wood stove/insert?

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You may qualify for significantly higher discounts
and/or interest-free financing.

Depending on your household size, combined gross annual income, and current heating source(s), you may qualify for additional funding for the purchase and installation of specific new heating devices and systems, and for making your home more efficient, as well as low- or no-interest financing.

To be eligible for the income-qualified program, the combined household income must be less than or equal to the following:

Combined Annual Household Income Thresholds

from: http://www.huduser.org/portal/datasets/il/il10/wa.pdf

Do you want to apply for the income-qualified program that allows for additional funding for the purchase and installation of a new heating device and for making your home more efficient?

YesNo

What's next? We will keep your information on file and contact you when program details have been finalized. We hope to announce a new program in early 2012. If you are eligible, you will be mailed or e-mailed (if you provided your e-mail address) program instructions.