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��� <br />C�� <br />9�N <br />r � <br />H G <br />MH� <br />� V1 H <br />x <br />��d <br />�/��g <br />y� V � <br />H <br />zH <br />�yH <br />ge� <br />���+1 <br />�Hfn <br />HOtn <br />�TOfV <br />PCRO�GERAM <br />- v, <br />Building �ecord <br />ClASSiFICATfON <br />(please chocA ono� <br />❑ New Building ❑ Addition over 500 sq. ft. <br />Jurisdiclion_____._____..--_— ------ - <br />� Cit ❑ Coun� <br />please check one___ � _—Y---- <br />A. Site Information <br />C(���fP9A . � . <br />�� �I�I�Ct # <br />AttadimeM B <br />(please chnck �e) <br />❑ ;ingle Family ❑ Dup!ex <br />❑ Multi(amily ❑ Zero �ot Line Home <br />0 Planned Unit Development _ <br />Permit #_____ —. <br />File_ID #_(ir di(ferent I•om Permit �j _ ___ __ ___ __-- <br />CONSTRUCTION ______ �'�r` <br />City_ - Z�P --- <br />Assossor s Pfopefty Tax #lor anacn �oga� descrpnon1 : <br />-- -- -- - <br />----`--- _ <br />Servicing Eleciric Ulifity _ __ -__ - .- - <br />C. If Single Family, Zero Lot Line or <br />Planned Unll Development <br />Total Conddioned Floor Area __ <br />Second Duplex Unit ___ __ _ _ <br />�� � A. Primary Spece Heal Type <br />� � (check one� __ <br />❑ Eleclric Baseboard <br />❑ Electric Furnace <br />��) � ❑ Electric Heat Pump <br />� <br />❑ Other (sperr�y ee�ow/ <br />SOMPLIANCE <br />WSEC Complfance Method <br />❑ Prescriptive Path <br />❑ Component Periormance <br />❑ System Analysis <br />B. Owner Informatlon _ __ _ <br />Owner (owner ar arr�e or mretn�crbn recelNes ua6h varme�Q <br />�� _ <br />CompanY---- ---- -- <br />Addr2ss__ _ _ _._-- -- -- <br />City-- -------State --Z�---- <br />Phone _ L- =--)— '_ .,— -- <br />Federal_ID# or SSN_______ _ __ _ — <br />D. If Multifamily (R_t) <br />Total # of Buildings <br />Sy, R, Total # of Units <br />Sq, ��, Total sq. ft. (optional) <br />HEAT SOUWCE _ --_-__- _.-. <br />B. Back-Up Spnce HeatTrpe <br />(opllonal, check ell lhaf app y) <br />❑ None <br />❑ Wood <br />❑ clectric Baseboard <br />❑ O�her lspecity be�nwl <br />C. Water Heat Type <br />(opflonal, chock one) <br />❑ Electric <br />❑ Gas <br />❑ Other (speciry belowl <br />INSPECTION/ENFORCEMENT _ <br />Date of Permil Application <br />Date Build� Permil Issued _ <br />Date of Insula�ion Inspection _ <br />-- -- ___ <br />Da!e ol f'inal Inspection . . _ <br />1 hereby certlly that thls buJfding or addlflon has 6een Inspecfed !or fhe measures required <br />by the 1991 Washington State Energy Code (WSEC), that it !s !n substantlal compliance <br />wlth fhe WSEC, and thaf fhe WSEC checkllst for t,his building !s on lile. <br />S� InaNro ol �uild�ng Otficial ar Aulhorized Repiosenlalive <br />DaIL <br />Return whlte copy lo: Kathleen Skaar, Washinglon Stale Energp Oflice, 809 Legion Way S[, FA-11. Olympia, WA 98504-1211 <br />INSEO - Whrtc Cepy U�Jiry� Owncr � Cdnary Copy Junsdicfron � Pink Copy g.g� <br />