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� �� <br /> Q � x <br /> � Hti <br /> y � H <br /> K n <br /> H � <br /> y y � INGTON � r Attachrent e <br /> � �� Building Record ��« <br /> o� �� <br /> ��g �Ran� <br /> � y� CLASEIFICATION <br /> yy <br /> �please cM1eck o�e) (pleasr chetk one) <br /> �d�' ❑New Building ❑Addltion over 500 aq.ft. ❑Single Family ❑Duplex <br /> � � Jurisdiction: ❑Multilamily ❑Zero Lot Line Home <br /> y '� 0 Planned Unit Deyelopment ____ _ _ <br /> H O!n ------ —�-- --- ---- <br /> piease cneck one___. , 0_Ciry _ L�___County__ _ , _ Permit# _ ___________ <br /> File ID#(il diNerem Irom Pe�mif N� _ _ _. _. <br /> CONETRIICTION ._ <br /> A. Site Informetion B. Owner IMormetlon <br /> Address Ow_ner .�own�v nr nme o_r x�m.en_an receiws untityvaymen�/__._ <br /> — --- <br /> City Z�P . Company -- _ � —- --- _ <br /> - — - _ <br /> Assessor's Property Tax#(or nrracn�egar eesoiprion/ : Address _ . _ . . ._ . _-_.. -_ _.—_—. <br /> City . _ . __ _ State - Z�p --__ : <br /> Servicing Electric Utility _ _ . Phone { __ ._ ) ____ _ _ __ <br /> '�t Federel IDq or SSN . , , _ , _ <br /> ��' C. If Single Family,Zero Lot Line or D. II Multifamlly(R-1) _ <br /> � Plenned Unit Development Total q o(Buildings <br /> � � Total Conditioned Floor Area sq.ft. Total#of Units <br /> � ' Second Duplex Unit sq.it. Total sq. it.(optional) _,'____ __ __. ___ <br /> � <br /> �—� HEAT 80URCE _ __ . --- <br /> -------- - — -- — _ <br /> ��� A. Prlmary Spece Heat Type B. Back-Up Space Heet Type C. Water Heat Type <br /> (check ana) (opflanal,check ell fhal epply) (opflonel,check ons) <br /> ' ❑ Electric Baseboard ❑ None ❑ Electric <br /> ' ❑ Eleclric Furnace ❑ Wood �) Gas <br /> ❑ Electric Heat Pump ❑ Eleciric Baseboard ❑ Other�spx�ty beawi <br /> �' ❑ Other lsPea�y berowl ❑ Other IsPeciry berowl ---.-- -- ----_.-----_—. <br /> 1 _ .__ .. <br /> ' �p��E ___ INBPECTION/ENFORCEMENT __ <br /> ' WSEC Compllance Method Dato of Permit Application <br /> � ❑ Prescriptive Path Date Building Permit Issued <br /> -- _ <br /> ❑ Component PeAormance Date oi Insulation Inspection _ <br /> ❑ Syslem Analysis Date of Final Inspection <br /> I here6y certi/y that fhls bullding or addltlon has been/nspecfed lor fhe measures requlred <br /> by fhe 1881 Washington Sfafe Energy Code(WSEC), thaf If Is In subsfant/al compllance <br /> wlfh the WSEC,end that fhe WSEC checkllet loi fhls building!s on flle. <br /> SignaWre ol�utlding 016cial or ANhonraA Ropresenlalivo Dale <br /> Return whlle topy to: Kathleen Skaar. Washington Slate Energy Otlice. 809 Legion Way SE.FA�11. Olympia.WA 98504�121�1 <br /> WSEO-W�ReCopy UGIityOwnci CanaryCopy Jw�cNCHun-PinFCopY g-g� <br />