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� � � <br /> D� x <br /> Ca H <br /> t"x> y <br /> H2H <br /> �i f] <br /> H :U <br /> �y � �1 � , . <br /> ul\nV <br /> o� d Building Record ��� A`�`�"` 8 <br /> � �8 ��ann <br /> �y � _ cussiFic�noN -- <br /> �y(~A y (please cheth onel (please thech onel <br /> n d y ❑New Buildlnp ❑Additlon over 500 aq.fl. ❑Single Family ❑Duplex <br /> 7� t� � Jurisdiction: ❑Multifamily ❑Zero Lot Line Home <br /> L�y �Planned Unit Development <br /> H O fn --- ----_ _ .. - . - . .------� - <br /> -- -- <br /> p�eese cnocq one ___� Ci��Oounty_„_____ Permn#_.. _ ___ _ _ __ . ______ <br /> FiIB ID#(�I dinerent liom Permd Nj _ . _ . <br /> ��� <br /> A. Site Inlormatlon 8. Owner Inlormation <br /> Address _ _. Owner__�a.na ar nme o�mnsm�crion a�cei�rs utl yrt psymen�_ <br /> Ciry Zip _ Company _ - <br /> Assessor's Property Tax p �o�xrrech iegai aesc��pnan� : Address <br /> Ciry State Zip <br /> Servicing Electric Utiliry Phone ( ) ' <br /> Federal ID#or SSN . _ __�,___ <br /> � � <br /> � ' C. If Single Family,Zero Lot Line or D. II Multllemily(R•1) <br /> Planned Unit Development Total q of Buildings _ <br /> � ' Total Condilioned Floor Area sq.ft. Total k of Units __ _ <br /> ' ' Second Duplex Unit sq. fL Total sq.It. (optional) _ _ ___. <br /> �_1 NEAT80URCE _ _ --------- <br /> ��� A. Primery Space Heat Type B. Bec��si,rchePk eBrHe eppY� C� (op ioneFi,�eneekyane� <br /> (oheek o�x1 f P . � <br /> �' ❑ Electric Baseboard ❑ None ❑ ElecVic <br /> ' ❑ Electric Fumace (-1 Wood ❑ Gas i <br /> I ❑ Electric Heat Pump ❑ Electric Baseboard ❑ Other�sper�ry berow� <br />, '� ❑ Other lspecity be�owl ❑ O�her lsPecAy eelowl .___ . . . .. _ _ . . <br />� �I <br /> '-' �� INSPECTION/ENFQRCEMENT <br /> ' ' WSEC Compllence Method Date of Permit Application <br /> ❑ Prescriptive Path Date Building Permit Issued _ <br /> ❑ Component PeAormance Date o�Insulation Inspection _ <br /> ❑ System Analysis Date ol Final Inspection <br /> 1 hare6y cert/ly thaf fh/a bulld/ng or addlflon hes been lnapecfed lor fhe measuree requlred <br /> by fhe 1891 Wash/ngfon Sfafe[nergy Code(WSEC), fhef If Is In aubsfanfla/compUance <br /> wlth fhe WSEC,and that the WSEC checkllst lor this bullding Is on Ille. <br /> Signature o�Buddmg Olhcial or pulhonTed Rep�esen�a�rve ���� <br /> Relurn wh�te copy to: Kathleen Skaar, Washington Slate Energy Oftice, B09 Lc9ion Way SE.FA 11. Olympia WA 98504�1211 <br /> W;EO W�rtrCopy Uhlip�Owne� Cdn��ryCopy Jrnsd�d�on-P�nACopy 6.9� <br />