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'. � � ��� <br />4r■ <br />-�, , � <br />�Y-�.-� <br />r � � <br />..�'�•�CI. . <br />� <br />Building <br />(pkase check one) <br />�4,risw suuai � Addftion ove�soo sy. n. <br />Jurisdidion: <br />�,b.� d�de or�: Ckv : 0 Counri <br />A. Sits Informatlon <br />C. H Sinpls Femlly, Zero Lot Lins or � D. <br />Plannsd UnR Dsvelopmsnt � <br />A. Primary Spacs N�t Typs <br />(� �) <br />❑ Electric Baseboard <br />�, Efectric Wall Heater <br />❑ Electric Fumace <br />❑ Electric Heat Pump <br />❑ Other <br />Record <br />First Duplex Unit <br />/ <br />�� 9 ,�Q. �is <br />A1�dnbnt B <br />��� <br />ChBCkOI16f <br />Single Family ❑ Duplex <br />❑ MulBfamily ❑ Zero Lot Line Home <br />❑ Planned Unit Develo ment <br />Pertnk �1 a <br />Fil6 ID M(HdHlerent /rom Permit A1 <br />B. Owner Informetlon <br />• ,: � <br />,' .,�.:, - <br />. <br />�.. : i:� � <br />. .. ' ' �, ' <br />- . = i . . � ; r . <br />B. �dNc�kN/ffiit� �� <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other (spedybelow) <br />E. M MultHei <br />ft. Total # of <br />C. Water Heat Type <br />(eh�ck orr) <br />� Electric <br />❑ Gas <br />❑ Other (apecrrybelow) <br />tarx.ePuroa�yl � • � <br />WSEC Compllancs Method Thls bulldiny meeta tha Date of Pertnit Appflcation ,f� 9- qS <br />�PrescripUve Path l�. eiectric Date Buildina Permit Issued /� -�a -�S� <br />❑ Component Perfortnance ❑ other fuels Date of Insulation Ins ion - - <br />❑ System Analys(s requirements of ths WSEC. Date of Final Inspection -/2 -Q$ <br />I heroby cs�N/y fhat thls bulldl� <br />by fhs 1991 Wiahlnyton State <br />�l� ths IN�EC^and t��he,Yl <br />BulWinp OtHcial or <br />or add/Gon has besn /napected Ior the meesurea requ/red <br />bry�r Code (WSEC), th�t !t la /n subatanHal compllance <br />Date <br />Retum wnar�opy to the servicing electric ufility to trigger WSEC compliance payment <br />Return whlte copy to• Kathleen Skaar Washington State Energy Office P.O. Box 43165 Olympia, WA 98504-3165 _ <br />WSEO - White Copy UtilityNwner- Cenary Copy Junsdicfion - P�nk Copy <br />12-92 <br />