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r ��. <br /> ��� x� �� ('�.' �G- y b <br /> Building Record ��� "`�"` B <br /> �� <br /> (please cneck one) �(p�e�check one) <br /> ❑New Bullding Additlon over 500 sq.tt. L7Single Family ❑Duplex <br /> Jurisdiction: t ❑Multifamily ❑Zero Lot Line Home <br /> _ �Planned Unit Development <br /> Wease cneck one: iN ❑Countv Permit# �' 3�.5.7� <br /> FiIB ID#(iltliNerenf hom Pe�mit At <br /> A. Site Information B. Owner Information <br /> Address o?Zl , J Owner arameacons receives <br /> � dlidi 2LiimQn+ <br /> Cit� �(��Q,� Zip 20 3 Com an <br /> Assessor'S Pro e Tax# oiattacn le al descri tion : Address �o -7� / _ <br /> �af �/� /v9_D/Z. r(� /, ciN �N�d� te '�zip ,P2C13 <br /> Servicinq Electric Utilitv� �y/��'L, � Phone (20��`�����fIL� <br /> Federal ID#or SSN <br /> C. if Single Famlly,2ero Lot Line or D. If Multifamlly(R-1) <br /> Planned Unit Development Total#of Buildings <br /> Total Conditioned Floor Area /Q/ (3 sq k Total#of Units <br /> Second Duplex Unit sq.ft. Tatal sp.ft.(optionap <br /> A. Primary Space Heat Type B. Back-U� Space Heat Type C. Water Heat Type <br /> (eMsek one) (eheek a fhat apply) (eheek o�) <br /> ❑�iectric Baseboard ❑ None �'�lectric <br /> 0�Electric Wall Heater ❑ Wood ❑ Gas <br /> ❑ Electric Furnace ❑ Electric Baseboard ❑ Other(specrrynerow) <br /> ❑ Electric Heat Pump ❑ Other/sPec��yee�ow� <br /> ❑ Other <br /> This bullding meets the WS Complfa�ce Method Date ot Permit Applicatian /0-3G-92 <br /> ❑ Electric Pre�h i Date Buildin Permit Issued - / - <br /> ❑ Qther Fuels ❑ Component Performance Date of Insulation Inspection cj- -7 9 <br /> requlrements ot the WSEC. ❑ System Analysis Date of Final Inspection �Z yj <br /> I hereby cerN/y that thls bullding or addltlon has been inspected/or the measurea requlred <br /> by the f991 Washington t Energy C (WSEC), that!t is In substantlal ttompliance <br /> wit the WSE an WSEC ltst/or this ildin,Js on flle. <br /> � l`6 ' <br /> Signature of Building Officia or Authorized Representative Date <br /> Return white copy to: Kathleen Skaar, Washington State Energy Office, 809 Legion Way SE,FA-11, Olympia,WA 98504-7 2 7 1 <br /> - WSEO-White Copy Utiliry/Owner-Canary Copy Jurisditfion-Pink Copy <br /> 7�92 <br />