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��� <br />� <br />9HN <br />H�� <br />�H� <br />a�H <br />�a � <br />K3�� <br />�/��8 <br />y� V C] <br />t"y� <br />r� H <br />g rn <br />cq�t7� <br />[q � t�l <br />z H f/r <br />HO�n <br />WASHINGTON <br />�ERGY <br />PROGFi�M <br />� <br />Suilding Record <br />Attadxnent B <br />`. � ' ' CLAS8IFICATION <br />(please clreck one) (P�ease check cne) <br />l� New Building ❑ Addltion over 500 sq. ft. ❑ Single Family ❑ Duplex <br />Jurisdiction: ❑ Multifamily ❑ Zero Lot Line Home <br />--------- --- <br />❑ Planned Unit Development ___ <br />gsasecheckonn: ❑ City ❑County Permitk � _ _ _____ <br />FIIB ID il (Adil'r�onf lmm Perm4 tlj_ <br />�" ' ';" CONSTRUCTION ` i <br />A. Slte Information <br />AOOfBSS �-7— <br />_ —_./�� <br />Assessor's Propey Tax #1or arra_cn iegai desa�prro"� _ <br />-a`- --- ------ - <br />Servir.ing Electric U�ility ____ ___ _ <br />C. If Singlu Famlly, Zero Lot Line or <br />Plnnned Unit Dovelopment <br />— --___.. — -- <br />Total Conditioned Floor Area sq. ft. <br />-- - <br />Second Duplex Umt ___ ___ sq. ft. <br />A. Primary Space Heal Type <br />(check one) _ __ _ _ _ <br />❑ Electric Baseboard <br />❑ E�ectric Furnace <br />❑ Electric Heat Pump <br />❑ O1hBf (specity bolow) <br />' __ YYIII� i�I1nV <br />_ �_ <br />WSEC Compllance Method <br />�, ❑ Prescript�ve Path <br />❑ Componenl Performance <br />� .n. <br />❑ System Analysis <br />B. Owne� Information <br />Gwner lavr•er ar r me o! cnissm�ctbn iec�ws uti�M paymenq <br />Company - -- ----- ---- -- <br />Address <br />Ciy . _ _---State � -- <br />Phone_ --L -----�------- <br />Federal IDq or SSN <br />D. If Multifamily (R-1) <br />_ _ --- --- <br />Total # of Buildings _ _ _ _ <br />Total # of Units _ ____ <br />To�al sq. IL {optional� _.__ ___ _---_----- _ <br />HEAT SUURCE _ _ <br />B. Back•Up Space Heat Type <br />(opflonal, eheek all thaf npply) <br />❑ None <br />❑ Wood <br />❑ Eleciric BaseL�ard <br />L7 ��h@f (specily belon9 <br />C. Water Heat Type <br />(apllonel, check one) <br />❑ EIeC�fiC <br />❑ Gas <br />❑ Other (s,vtci/y beawl <br />INSPECTION/EiYF08C�iVIENT <br />Da�e of Permit Application <br />Date Building_Permit Issued ___ <br />Date o( Insulation Ins�ection <br />Date of Final Inspection _ <br />I here6y certlly that fhfs 6ulld/ng or addltlon has been Inspected /or the measures requlred <br />by Ihe 1991 Washington Sfate Energy Code (WSEC), that lt !s (n subsfanflal compllance <br />with the WSEC, end that the WSEC checklist lor this bullding !s on lile. <br />__ <br />SignaWre o� Builtling Oflicial or Aut9orized Nepresenfalivo <br />Uate <br />Return white copy to: Kalhleen Skaar, Washinglon Sta�e Energy ONice. 009 Legion Way SE, FA�11. Olympia. WA 98504-1211 <br />WSEO � Whrte Copy Ufdrty Owncr - Can.iry Copy Juusd¢fron - Pink Copy 8.91 <br />