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� �� <br /> p�M <br /> C H <br /> � Hy <br /> y � H <br /> K n <br /> H � <br /> '�1�-�y • <br /> y� , i <br /> � � d � � Buildinn, Record W'S��# Atfad�d B <br /> o � �� <br /> �� g �oc�nn <br /> �y� CLA881FICATION_ ' <br /> y y — <br /> H (plense check onel lp�cam checw a�e) <br /> ��yr ❑New Bullding ❑Addition over 500 sq.ft. ❑Single Family ❑Duplex - - <br /> M Jurisdiction: ❑Multifamily ❑Zero Lot Line Home <br /> y yo y n Planned Unit Develo�ment____ <br /> --- - ---------. - — <br /> � Ci� ❑Count __ Permil_# _.___-------- <br /> p�ease cneck onc --- . -Y----y -- - <br /> —�- F118 ID H(if diHerem lrom Peimif A) _ -- . <br /> C�� <br /> A. SNe Informetion B. Owner InformeNon __ <br /> _ <br /> AddreSs .� .. - . Owner (awna'at nma ol roranuctan roceiws un�l peymenll -. <br /> City Zip CompanY - -- _-- <br /> Assessor's Property Tax#�or arracn iegai descnpnoN : Address - <br /> City � State Zip_J__ <br /> Servicing Electric Ulility _ _ Phone ( ) - - <br /> '�' Federal IDN or SSN -_'— <br /> ��' C. If Single Femily,Zero Lot Llne or 0. II Multllemlly(R•1) <br /> '�' Planned Unit Development Total N of f3uildings _ <br /> Total Conditioned Floor Area sq.ft. Total#ol Units <br /> ��� Second Duplez Unit sq.IL To�al sq.ft.(optional) _ ______ <br /> �-� NEAT SOURCE _ -- -. _-_ - --- - <br /> _ _---- <br /> '�' A. Primary Spece Heat Type B. Back-Up Space Heat Trpe C' WPjjoneNchxkyonsJ <br /> �' (eheek one) (opllonel,eneck all fMaf app y) <br /> ❑ None ❑ Electric <br /> ' ❑ Electric Baseboard �J Gas <br /> ❑ Electric Furnace ❑ Wood <br /> ❑ Electric Heat Pump ❑ [lectric Baseboard ❑ OihOf (speN�y hebw) <br /> f=' ❑ ��h0f(sPecrlybclowl ___.._._.. ___—_—______ _._ <br /> ❑ O�hef (specity belowl <br /> �' <br /> '_' ���E _ _INSPECTIOIUENFORCEMENT <br /> ��' WSEC Complience Method Date of Permit Application <br /> Date Building Permit Issued _____ _______. __ <br /> ❑ Prescriptive Path - - <br /> Date of Insulation Inspection ___ _ _ ____- <br /> ❑ Componenl Perlormance Data ot Final Inspection <br /> ❑ System Analysis <br /> 1 hereby cer111y thaf thla 6ulld/ng or addlf/on has been Inspecfed lor fhe measures requlred <br /> 6y the 1981 Waehington Slafe Energy Code(WSEC), that!t!s in substentlal compl(ance <br /> wlfh fhe WSEC,and fhaf the WSEC checkllsf lor fhis butlding!s on llle. <br /> Signa0.ne o�Owlding ONicial or Aulhorued Fepmsentalive <br /> oale <br /> Retwn rihlle copy to: Kathleen Skaar, Washington State Eneigy Oflice, 809 Le�ion Way SE.FA-11. Olympia.WA 98504-1211 <br /> WSEO�Whrto Cop y <br /> UNity Owner Canary Copy Junsdiclmn�PmF Cap� 6-g1 <br />