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HnH <br />� � <br />H <br />Q H <br />�Hy <br />H�� <br />FC C] <br />'�tl H ��d <br />yy� <br />�O <br />OHd <br />��g <br />C�iY (� <br />C"y� <br />gyy <br />C] Cl7 �n <br />�]r�.y <br />Hy <br />H O fn <br />� <br />� ��� <br />;v>;.. <br />♦� � <br />..� .. <br />Building Record ��# �'` B <br />NG� 1 I'I Gt1 �t �' � l( �=��.; � G D� t' <br />(please check one) <br />� New Bullding ❑ Addition over 500 sq. tt. <br />Jurisdiction: t= � 4� p rl <br />pleaso check one: � Citv ❑ Countv <br />(please check one) <br />❑ Single Family �'Duplex <br />❑ Multitamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit # ,: S `/ �=� <br />FIIe ID #(il diNerent Fom Permit A1 <br />.. 4.e ' Q�4�1� ��- a.. 4+T�'4.-�. -s <br />xv':a�.�.tas.�.�...��":� " xi�'at. � %F�".:.��:3�.x .'� . � , . <br />A. S(te Information B. Owner Informetion <br />Address Owner (ownerernmeo�ca�ssmatlonreceivesun�nruarmeml <br />�, ;� r� i:al? -1�,�,• ��. Ji <br />Citv �, i y� r,, �_ ZiP ��ti I ComPanY ,_f �. �� i, �l c n� i <br />Assessor'S PropBrtV Tdx # (orattach lepal descnption) : AddreSS � .. �V —,`r 6,' � � ('1 I; _ <br />Citv i= � a i� l l State �,1; � ZiP v i=?[Jl <br />Servicing Electric Utility Phone ( ,L; � l- 1 -; ; 7 - -�G, �; � <br />Federal ID# or SSN <br />C. If Single Famlly, Zero Lot Llne or <br />Planned Unit Development <br />Total Conditioned Floor Area T� (, �> sq• ft._ <br />Second Duplex Unit sq. ft. <br />D. If Multifamlly (R-1) <br />Total # of Buildings <br />Total # of Units <br />Total sq. ft. (optionaq <br />a, �l `���";�'ti�r�,$��,T��„�'-.�,�#�',�����A�wf ����� �'�'� r +,�" " *` ��x � �� s'� <br />> <br />f�' I A. Primaty Space Heat Type <br />(check one) <br />1 ' i ❑,—, /Electric Baseboard <br />� �!� Electric Wall Heater <br />'-1 ' ❑ Electric Furnace <br />❑ Electric Heat Pump <br />�� ❑ Other <br />B. Back-U� Space Heat Type <br />(checka thatapply) <br />None <br />❑ Wood <br />❑ Eleciric Baseboard <br />❑ OthQr (speci�ybelow) <br />C. Water Heat Type <br />(cneek one) <br />�lectric <br />❑ Gas <br />❑ OthOf(speci/ybelow) <br />. ,_ � . � ,. .. <br />� � ' 4`�MP1�U�E ,. _ , •, � �;� �� <br />�>.. , a�.�.=. �.�: <br />This, �b,�uilding meeis the WSEC Compllance Method Date of Permit Application ;, -� S- 9U <br />lli'Electric ❑ Prescriptive Path Date Building Permit Issued ,-i - j- Q/ <br />❑ Olher Fuels �Component Performance Date of Insulation Inspection :-��{5--� <br />requirements of the WSEC. ❑ System Analysis Date of Final Inspedion ; >' S—�� {_ <br />I hereby certl/y that thls bullding or addltlon has been lnspected /or the measures required <br />by the 1991 Washington State Energy Code (WSEC), that It ls fn substenNa/ compllan�e <br />wlth fhe WSEC, and thaf the WSEC checkllst /or fhls building Is on flle. <br />� s.^ r? „ _i' -1 ' ; T <br />Signature of BuiMtfig ONicial or Authorized Representative Date <br />Return white copy to: Kathleen Skaar, Washington State Energy Otfice, 809 Legion Way SE, FA-11, Olympia, WA 98504-1211 <br />WSEO - Whife Copy Ufility/Owner - Lanary Copy Jurisdiction - Pink Copy <br />7-92 <br />