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<br /> Building Record � ,�p�t� A�� B
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<br /> New Building Addkion over 500 sq.ft. ❑Single Family I�'buplex
<br /> Jurisdiction: ❑Mukifamily ❑Zero Lot Line Home
<br /> ❑Plannrd Unit Development
<br /> dease cnecR one: Ckv ❑County Permi?# SL'�37/
<br /> FIIB ID#(ildiHerentlromPermit.Jl
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<br /> A. Site Information B. Owner Infortnation
<br /> Address � �
<br /> 'S�o_�� .I.P/YI,LUdO i Owner otxier tOmeolconstr 'onrecei�esu[i menf
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<br /> CitY „CLYq,.L,t�"i Zip ��03 Com an --
<br /> Asses or's Pro ert Tax It or artaon�e ni ds:cri no� : Address X
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<br /> Servicin Eleciric Utilk /�ul Phone� ( �1�, ) 7 7Sr -r,�ri -�r.5-
<br /> C. It Single Family,Zero Loi L(ne or � D. Duplez E. If Multifemily(R-1)
<br /> PlannEd UnR Development Flrst Duplex UnR S sq.tt. Total�k of Buildings
<br /> Total Conditioned Floor Area s . ft. Second Du lex Unit .� .ft. Total#of Unfts
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<br /> A. Primary Space Heat Type B. Secondary Space Heat Type C. Wate�Heat Type
<br /> (cAeek one) (ahxk all tFiet app/y) — _ (check om) _
<br /> ❑ EI nc Baseboarcl ❑ None ' \. Electric
<br /> Electric Wall Heater ❑ Wood ❑ Gas
<br /> ❑ Electric Furnace ❑ Electric Baseboard ❑ Uther(spacirybelow)
<br /> ❑ Electric Heat Pump ❑ Other�speciyba�ow)
<br /> ❑ Other
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<br /> .�. �. .W Qor Hwt Po�ry OnM ' /
<br /> WS�E,.C,�Compliance Method This buildtng meets the Date of Permk Application �/�p- y
<br /> L"f Prescriptive Path ❑ electric Date Buildinn Permit Issued "/.3-
<br /> ❑ Component Pertormance ❑ other fuels Date of Insulation Inspection �� in-i�-4�
<br /> ❑ System Analysis requirements of the WSEC. Date of Fnal Inspection �-7-45
<br /> 1 hereby certlfy thaf this building oradditlon has been inspecfed/or the measures requlred
<br /> by the 1991 Washington State Ener Code(WSEC), fhat it Is!r su6stantial compliance
<br /> wffh the WSEC, d that t WS hecklfst for thls building is on file.
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<br /> SI aN of Buiidng tfldal or Authoriz Representa0ve Date
<br /> Return canary copy to the servlcing electric utility to trigger WSEC compliance payment
<br /> Return whlte copy to:Kathieen Skaar,Washington State Energy Oflice, P.O.Box 43165 Olympia WA 98504-3165 �Z�92
<br /> WSEO-Whife Copy UAliry/Owner�Canary Copy Junsdicfion-Pink Copy
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