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H (] H <br />iC 'rr7A9+ �V <br />CC10 <br />to <br />Ly9 <br />C H <br />y nH <br />b H o <br />in H <br />N � G <br />H ',',',ppppTTTTLLLlpppp,,,, <br />H H <br />N <br />M <br />Cx O N <br />pp y� HR V; O in N <br />c3 <br />11J <br />ib <br />NOTON <br />ODEFiAM <br />K <br />Building Record <br />CLASSIFICATION <br />(please check one) <br />❑ New Building ❑ Addition over 500 sq. ft. <br />Jurisdiction__ ---- ------ <br />please check one ❑ city ❑ County - <br />WSEO Contract # <br />(please check one) <br />❑ Single Family ❑ Duplex <br />❑ Multifamily []Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit# ',,'!- <br />File ID # (if different Irorn Permit ki _ <br />Attachment B <br />CONSTNUCTNIN <br />B. owner information <br />A. Site Information Owner (owne attmeorooretns u61M payment) <br />ctonreoe <br />Address <br />Assessor— s Property Tax # for attach legal description) <br />Servicing Electric Utility _ <br />Company <br />Address <br />City State ` p <br />Phone ( ) <br />Federal ID# or SSN <br />D. if Multifamily (R-1) <br />C. If Single Family, Zero Lot Line or Total # of Buildings <br />Planned Unit Development _ _ <br />sq. it. Total # of Units —_ <br />Total Conditioned Floor Area Total Sq. ft.(optional-_ ) _ ---- -- <br />Second Duplex Unit- <br />NEAT SOURCE - -_-- <br />A. <br />Primary Space Heat Type <br />(check one) <br />❑ <br />Electric Baseboard <br />❑ <br />Electric Furnace <br />❑ <br />Electric Heat Purnp <br />❑ <br />Other (specify below) <br />B. <br />Back -Up Space Heat Type <br />(optional, check all that app y <br />❑ <br />None <br />❑ <br />Wood <br />❑ <br />Electric Baseboard <br />❑ <br />Other (specify below) <br />C. <br />Water Heat Type <br />(optlonal, check one) <br />❑ <br />Electric <br />❑ <br />Gas <br />❑ <br />Other (specify below) <br />E- INSPECTNRKWORCEMENT <br />COWLIANC <br />Date of Permit Application — -_ <br />l _WSEC compliance Method Date Building Permit Issued — <br />❑ Prescriptive Path Date of Insulation Inspection <br />❑ Component Performance Date of Final Inspection -- <br />❑ System Analysis - --___74 <br />- <br />1 hereby certlly that this building or addition has been inspected for the measures required <br />by the 1991 Washington State Energy Code (WSEC), that It is In substantial compliance <br />with the WSEC, and that the WSEC checklist for this building is on file. <br />Signature of Building official or Authorized Representative <br />white copy to: Kathleen Skaar, Washington State Energy Office, 809 <br />WSEo - White Copy utility/Owner - Canary Copy <br />Date <br />Jurisdiction -Pink Copy 1 6.91 <br />