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v�✓ <br /> Build6ng Record „�,,,�� "'� B <br /> . <br /> �!a •aB nreck wie, rae ,B cnedc c�e, <br /> New Bulidl 9 Addi lon over 500 sq,ry, � <br /> Jurisdiction: � i p �an e� inple Family ❑puplex <br /> ❑Multifamily ❑Zero Lot Line Home <br /> � ❑Planned Unit Develo ment <br /> Eleeae dieak ons• CIN ❑CounN permit N 3 3[p <br /> File IU#�a�dme�emnumpe�m�rn <br /> A. Slts Inform�tlon B. Owner In}orm�tlon <br /> Address ,?'9i 7 �� ✓�. Owner o,.,,a. <br /> doaam�m, <br /> Cltv vii�1 ��„ � �n/ — -P�Jro..o oico <br /> � _ Comnanv — ' <br /> Assessof'SProoe TexM warcechboe�deacrbNon�: Address � <br /> 9�/�� /03 ° J��-- �� Citv /�.oT}- State f/ Zin �7 �O/ <br /> Servidno Electdc UUliri �,a C� 7�v� Phone ( SO 1 c9 B - <br /> .�_�3Lo <br /> C• If 81npN Famlly,Zero Lot Llns or D. Duplex <br /> Pl�nn�d Unit Dsvslo msnt E. I}Multlf�mlly(R•1) <br /> P First Duplex Unit sq.R. Total M ol Bulldfngs <br /> Total Conditloned Floor Area . R. Second Du lex Unit <br /> •h• Total 8 of Units <br /> A. Prlm�rY gP�Ms�t YYPe B. g�corM� <br /> ��n.aron.l _ ��N����HeelType C. WatsrHe�tType <br /> ❑ Electric Baseboard fO�ko"�) <br /> None ElecMc <br /> �Electdc Wall Heater ❑ Wood ❑ Gas <br /> ❑ ElecMc Fumace ❑ ElecMc Baseboard <br /> ❑ Electric Heat Pump ❑ Other/specnynero,,.� ❑ �►her�spenryee�ow� <br /> ❑ Other <br /> ndwennoa�n <br /> WSEC Compll�ncs Msthod Thla bulldlnp mesh ths Dete of Permit Appl(cation � _ ,� <br /> �PrescripNve Peth �electric Date Bulldino Pertnit Issuad . - - -- <br /> Component PeAormance ❑ other fuels Date of Insulatlon Insoection^ - �_ <br /> ❑ System Analysla roqulroments of ths WSEC. Date ot Final Ins[+or,�tion 1- _ — <br /> I hsroby cerN/y ryat fh/i bulldlnp or�ddlNon h�a bsen Jnapsctsd lor ths mseauroa roqulred <br /> by fhs 188f Wi�hlny�on Sta E ryy Code(WSEC), thet/f la In aubihntle/compll�nce <br /> � « � ,• af fh W C c e �r//jt for th/a bulldlnp/a on Nls. <br /> -/�y_S <br /> qnature o18ulMlnp Offic I or AuMurized Repreeentathre — <br /> Dete <br /> Return canary eopy to the servicing eleclric utiliy to Mgger WSEC compliance puyment <br /> _ Retum whlf�copy to:Kathleen Skflar,Washington State Energy OHice P.O. Box 43165 Olympla, WA g8504-3765 <br /> WSEO• Whife Copy Utiliry,t7wner-Cenary CopY ---�---- <br /> ✓unsOicYion-Pink Copy <br /> 1$92 <br />