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� y <br />q�� <br />�HN <br />��� <br />��� <br />y <br />yz <br />��ey <br />��g <br />QY (� <br />ryH <br />M <br />N <br />n�ti <br />��� <br />yy I IIIVLIII.nV <br />CO�� <br />y� <br />Building ord <br />�p�e check one) <br />New Building Addition over 500 sq. tt. <br />Jurisdiction: <br />olease check one• CitV ❑ COl1nN <br />p. Site Informatlon <br />Address �,j 7/ 9 �, ./� <br />�•,., . ,sn i �-. ��� q ? <br />ASSeSSof'S P�0 e T2X # or attach le 1 descri fion : <br />Servicinq Electric tilit <br />C. I( Single Famlly, Zero Lot Line or <br />Planned Unit Develooment <br />� � A' Prtie�ckone pace Heat Type <br />��' ❑ Electric Baseboard <br />� ❑ Electric Wall Heater <br />�� . ❑ Electric Furnace <br />' ❑ Electric Heat Pump <br />� [�Other _�iYi/i� <br />� <br />�� <br />� <br />W5E0 Cantract# <br />� ✓. Y : : <br />(please check oneJ <br />❑ Single Family �Duplex <br />❑ Multifamiiy ❑ Zero Lat Line Home <br />❑ Planned Unit Develo ment <br />Permit # � <br />Fi18 1 D# l i! diHerent from Permit p1 — <br />B. Owner Infortnation <br />Owner � owneratOfieofconstrucr' nrecr;vesubliNaarmenU <br />i�Jv J — <br />compan / <br />Address � Jl7 �O <br />CI� Staie�f.i Zi <br />Phone ( 2(J( 1 i5,s '[/ 77� <br />FedPrai ID# or SSN �i(1h'/.�'O2G0 <br />D. If Multifamily (R-1) <br />Total # of Buildings <br />Total # of Units <br />Total sq ft (optionaq — <br />B. Back-Up Space Heat Type <br />(check alI thet epplyJ <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Othe((specifybelow) <br />C. Water Heat Type <br />(check one) <br />Electric <br />❑ Gas <br />❑ Othdf (specilybelow) <br />Thls� -b✓pllding meets the W EC Compliance Method Date oi Permit Application Q% Z <br />i.ld Electric . Prescriptive Palh Date Buildin Permit Issued —.� <br />❑ Other Fuels ❑ Component Periormance Date of Insulation Ins ection —Z " 3 <br />requirements of the WSEC. ❑ System Analysis Date of Final Ins ection � Z <br />1 here6y certily that this 6ullding or addlNon has 6een inspected /or the measures requ� <br />by the 1991 Washington Sfate Energy Code (WSEC), that It Is In substanNal compllanr.e <br />�w�th t¢e WSE�an'd that the WSEC checkllst /or thi� uIJ�ding,ls�n file. — <br />L I ., w / /� <br />Building Otficial or Authorized Representative Date <br />p¢turn white copy to: Kathleen Skaar, Washington State Energy O(fice, 809 Legion Way SE, FA-11, Olympia, WA 98504-1211 <br />� WSEO - While Copy Ulility/Owne� • Canary Copy Jurisdicfion - Pink Copy <br />7-92 <br />