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;� - - - — - .—_ _ . <br /> � <br /> � -- <br /> I ;� �1 I <br /> ; Building Record ��» ""'�'""` ` !, <br /> � � <br /> � . �■- <br /> , <br /> ��: <br /> ' II (pl ase chenk one) (piease cneck one) <br /> �Nsw Bulldinp ❑Additlon over S00�q.fl. ($Single Family ❑Duplex I <br /> Jurisdiction: �, f-�� ,;-fi ,'= J. ' �."i�" ❑Multifamily ❑ZeroLotLi�eHome I <br /> ❑Planned Unit Development � <br /> p�eese cnecw one: Ciry ❑County Permit# /-//= �',�L � <br /> File ID M indn�arenr nnm rermrt�n I <br /> I <br /> � A. Sits Inform�tlon B. Owner InMrmatlon � <br /> � Address ,� • '� ,: - � :`'i Owner lownereretneamrsm,cnonrecenresunNvicem�enu <br /> � L <br /> CItV r - (,,{ 9 P7" ZIP ��a�,'l�- -, Comaarniu �,.= �= ;ir��.; I �'_.r. n '>'1 , - I <br /> Assessor'sPro�TaxN o�eeecn�epeldeecr�pxonl: Address �.�.'��.��,� ,���:J�r :�� <br /> ��l� :� •r% Y� - r7�.=� • � J�/ _ CIN �>>�f%�/;` Sfeie!'i.921P %QJ// <br /> Servicing Electric Utilitv r-; _ �=J u Phone ( .>:,i.- 1 .�;'- i�i' _ <br /> Ft.leral IDN or SSN <br /> C. N 81npN F�mily,2�ro Lot Lins or D. H MuRihmlly(R•1) <br /> Pl�nmd Unft D�vNopmsnt Total N of Buildings <br /> � Total Conditioned Floor Area f 25L sq,tt• Total N of Units <br /> Second Duplex Unit sq.ft. Totel sq.ft. (optlonel) �, <br /> A. PHm�ry Sp�cs Hstl Typ� B. B�ck•� 8�a INN Typs C. W�t�r INd Typ� <br /> (cMck or») f��* � �PMYI feMck on�J — <br /> ❑ Electric Baseboard None Electric <br /> � Electric Wall Heater ❑ Wood ❑ Gas <br /> Electric Fumace ❑ Eleciric Baseboard ❑ Other�nPecnyherowl <br /> ❑ Electric Heat Pump ❑ Other�spaei�ybeww� <br /> ❑ Other _ <br /> �. <br /> i F' <br /> Thls bylldlny msets ths WSEC Complimce MNhod Dete o(Permit Application � y-)�' <br /> �Elecirfc Prescdptive Path Date Buildin0 Permit Issued : � <br /> ❑ Other Fuels ❑ Component Perlormance Date of Insulatlon Inspection I/ !r, 9.�_ <br /> roqulremsnt�ot the WSEC. ❑ System Anelysis Date oi Final Inspectlon `z c -S •! <br /> I hsroby csrNly fhaf fhl�bulldlnp o►addlflon bas bNn Inspscbd lo►fM mraeunt nqulrod i <br /> by the f88f WishUDfon Shts E►Nlpy Cods(WSEC), fhaf!t li/n subat�nNd compllenro <br /> , wlfh fl,s WSEC,�►M fh�t fhs IySEC cha✓lr h- t for thli bulldlny,Ja on N/s. <br /> �� �> :���—T����`�'��� � � <br /> I Signalure M Bulldlnp OHicia�or Authodzed fiepranentetive Date I <br /> � <br /> � Return whits c�y to: Kathleen Skear, Washin on State Enerpy Olfice, B09 Legion WaY SE,FA-11, Olympie,WA 98504-1211 � <br /> ' WSEO-White Copy Ulility�Dwner-Canery Capy — --- Junadkfron�Pink Copy I <br /> I �a2 � <br /> � — _ � <br />