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��� <br /> p � x <br /> G I-i <br /> 9 H !n <br /> . xy <br /> Hx � <br /> K n <br /> '+tl�� � - � � " <br /> �� � ���,►� Building Record WSEOCantractM A��� B <br /> ° � �Ra�n <br /> ��� , <br /> H CLASEIFICATION <br /> H <br /> �y y y /please cneck one) fp��ase check onel �I <br /> ��y ❑New Bullding ❑Additlon over 500 sq.ft. ❑Single Family ❑Duplex <br /> Jurisdiction: ❑Multifamily ❑Zero lot Line Home <br /> ❑Planned Unit Devel�ment _________ ___ <br /> HO � . Permit# _—�—�---- -----�-- <br /> _0 Cit ❑CouM <br /> p�easecneckone:-- �-----y----- <br /> FIIB ID#(AdiNerenf Irom Permif X� _ .._ __ . _ - _ <br /> �11� <br /> A. SIIeIMormetlon B. Ownerinformallon ___ _ __,___ <br /> Address . Owner (ownnatnmoormrrstructionreca�sufiiiNpalmenU <br /> Ciry Zip Company - - _ .. --- _ <br /> Assessor's Property Tax# �ar auacn�egai desc�ipnon/: Address State Zi <br /> _..__ <br /> City - � P - - - <br /> Seryicing Electric Utility . _,__ _ _ Phone ( ) _ - <br /> Federal IDp or SSN , ��__..� <br /> ' ' C. If Sl�gle Famlly,2ero Lot Line or D. II Multlfamily(R•i) <br /> '�' Plenned Unit Development Total q o1 Buildings <br /> ' 1 Total Conditioned Floor Area sa.it. To�al#of Units _ ______ __ __ - <br /> '_' Second Duplex Uni, sc;.ft. Total sq.lt. (optional) _ _, _' __ __ <br /> `_) IIEAT SOURCE ----------- - <br /> ��' A. Prlmery Spece Heel Type B. BPcone ahePck eu�He eppr)e C (opfloneH eAxkYons) <br /> �c�ack one) <br /> '-1 ❑ Electric Baseboard ❑ None ❑ Electric <br /> f7 Electric Furnace ❑ Wcod �7 Gas <br /> ��' ❑ Electric Heat Pump ❑ Electric Baseboard ❑ Other�soedry beww� <br /> � ❑ Other �speatr oemwl ❑ Other�speciry newwl — <br /> —' - -- --- <br /> �- INSPECTIONIENFORCEMENT <br /> �' WSEC Compllenc�M��E Datc ol Permit Application <br /> ' ❑ Prescriptive Path Date Building Permi�Issued_ ______ <br /> ❑ Component Performance Date of Insula�ion Inspection_ _ ________ <br /> ❑ System Analysis Date of Final Inspection <br /> I hereby certlly fhaf fhls bullding or addltlon has been(nspected/or fhe measures required <br /> by fhe 1991 Weshington Sfefe Energy Code(WSEC),fhaf If le ln subefant/al compNance <br /> wlth the WSEC,and fhat the WSEC checkllst for this bullding!s on lile. <br /> SignaWrn of Building Olhcial or Authonzed Repiosentatrve ���� <br /> Return whlte copy to: Kathleen Skaar, Washington State Energy Otlice. 809 Legion Way SE.FA-11.JOIy�pi�,W��9������2C191 <br /> WSEO� Whiio Copy Uti6lpOwner-Canary Copy <br />