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� y <br />q�� <br />��� <br />��� <br />y <br />x <br />��d <br />a�c� <br />ry�H <br />y <br />O�N <br />�Oy <br />m <br />. � • <br />r <br />?J-�!-. <br />•� <br />..� .. <br />c\\� • <br />Building Record <br />�(plea�° check one) <br />[�'New Building Additlon over 500 sq. tt. <br />Jurisdiction: � ' <br />iease check one City ❑ CounN <br />A. Slte Information <br />A�idress S7/ (d�l� <br />c��v trinez�" /.�,4 za 9¢��— <br />ASSBSSorS Pf0 P, TaX orattachl aldescri han : <br />3 l �/ <br />oi � � i u'�ih, !' .� (� . �Uli <br />o +� — <br />C. it Single Family, Zero Lot Line or <br />W,SEo Gonlract# <br />(please check one) <br />❑ Single Family `�uplex <br />❑ Multitamily ❑ Zero Lot Line Home <br />❑ Planned Unit Develo ment <br />Permit # � Jl�r <br />File ID # f11 diHerent !rom Permft+tl <br />B. Owner Information <br />pltaclrnent B <br />Owner u�tt�erat Nme of 6vction re�'e� u6T ��� <br />L.� LL a <br />Com a� <br />HOUICJJ f v �I- <br />�,� �,�' State�C.�� ZiP .2 <br />Phone ( 2U�O � �� `'� �2—� <br />Federai ID# or SS� — <br />D. If Multifamily (R-1) <br />Total # of Buildings <br />Total # of Units <br />Total sq tt (optional) - <br />❑ Electric WaII Heater <br />❑ Electric Furnace <br />�❑, �lectric Heat Pump <br />I�J' Other �� <br />� <br />■ <br />■ <br />Wood <br />Eieclric Baseboard <br />OlhBf (specilybelow) <br />❑ Gas <br />❑ Othef (specitybelow) <br />-6 - � <br />This,,-,bryNding meets the WS C Compliance Method Date ot Permit Application /a -28 -9� _ <br />LI� Electric Prescriptive Path Date Buildina Permit Issued /�'�3 <br />❑ Other Fuels ❑ Component Periormance Date of Insulation Inspection L% L� <br />requirements of the WSEC. ❑ System Analysis � <br />Date of Final Inspection <br />1 hereby certNy that thls buJlding oi addltlon has been lnspected for the measures requlred <br />by the 1991 Washington State Energy Code (WSEC), that It Is !n su6stantJal compllan�e <br />_/ w/tq thq WSEC, a,�d thaf the WSEC checkllst lor thls bullding Is op ��/n' <br />SignaWre oiBuilding Oflicial or Aulhorized Represenlalive <br />Return white copy lo: Kathleen Skaar, Washing� <br />� WSEO - White Copy <br />Date <br />State Energy Oltice, 809 <br />Ufifity/Owner - Canary Copy <br />Jurisdicfion - Pink Copy <br />1211 <br />7�92 <br />