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<br /> ����„�� �. . • Atlaclune�d B,
<br /> � Bu�lding Record ,�o�� ,
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<br /> �'a.�>z� '� �s £v.v,y�.5°'�'s''.To.'�p�`s3?kY'Y'� a • et . �P�e Y �i7�n�`4$°f'y
<br /> "PM d�G A tta' Y�R� CQm+'+»i� SLr .� � F. s ...' . . . `J �7 0��'f4 t��:���,
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<br /> ,(�pMa e cheek one) (please check one)
<br /> f�New Bufldin ❑Additfon over 500 sq.tt. ❑Single Family ��plex
<br /> Jurisdiction: ❑Mukifamily ❑Zero Lot Line Home
<br /> ❑Planned Unit Development
<br /> � p�esa��r ona: �Z�rtv ❑CouMv PermR# •;�S37Z
<br /> , File ID#(il dillerenr�rom Permit M
<br /> v��+s z a,� . �R, . _ - .. ,, . �q.'y n . �p�``�"32¢?7�� Y.°' .p� ._
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<br /> � dv.3 _ T� '<��'�i x�¢�q. � " � .� .. �a�w.v` ' �.'a>i �.�,`�s�3'a,,.`°�S'«,�a 'i�.4�.
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<br /> � A. Site Iniormation B. Owner Intortnation
<br /> Address ��� i Owner oHnsrartlmedca+sevc� '�es
<br /> �rl/'Pihi l�lY
<br /> �� ��� Zi _,¢� Com a�n �
<br /> Assessor's Pro ert Tax# or attach le �al desai eon : Address /'U �`�3 Lo
<br /> � . - Z Citv V/7rY)u r� State Zi �QQ�l�
<br /> Servicinq Electric Utilitv �C'1�D � i Phon—e ( �1.,l 77�-��S'S'
<br /> � '
<br /> C. If Single Family,2ero Lot Line or D. Duplez E. If MultBamily(R-1)
<br /> Planned Un(t Development First Duplex Unit /� 7 sq.ft. Total#of Buildings
<br /> Total Conditioned Floor Area s .ft. Second Du lex Unit .tt. Total#of Units
<br /> � `a�.`��`� y 'L.����a�P'���h �����`�u�as�., �"� ... �!jn., .... ,���t.�.6 ��n.��§���"�i����;q",�,� ti�`.���,� ��.
<br /> � � � �;a. C>:....:x`L?..�, ''auE.:��'s'w x.. �z�.a'�" c?':y��?'afa`.�(`..��. >������N'I��t. x� A' a �... ." •Z�e t�.x.o ."SFCSfn..:2.�'.<,.xZ�e.:`&��._
<br /> A. Primary Space Heat Type B. Secondary Srace Heat Type C. Water Heat Type
<br /> (check one) (cheek aN t/iet app/Y) (check orreJ
<br /> ❑ Electric Baseboard ❑ None lectric
<br /> Electric Wall Heater ❑ Wood ❑ Gas
<br /> ❑ Electric Fumace ❑ Electric Baseboard ❑ Other�sped�ybelow)
<br /> ❑ Electric Heat Pump ❑ Other(specirybeiow)
<br /> ❑ Olher
<br /> . . . `��'�z2�c�������*i���'� � �� 5`�� ���.. ..�1 .:.y-3
<br /> �a "s�� �.'`�$'�u�`�"�.`� �.e �. ;.:Y..,. ?a'�£i.�. .�-: a.,
<br /> hor Hsal Punp only)
<br /> WSEC C pllance Method This building meets the Date of Permit Application �/ -
<br /> Prescriptive Path ❑ eleclric Date Buildinq PermR Issued /,��
<br /> ❑ Component Perfortnance ❑ other tuels Date of Insulation Inspection /�-.� Q�/
<br /> ❑ System Analysis requfrements ot the WSEC. Date of Rnal Inspection a - 7- 9S
<br /> I hereby certi/y fhat this bullding or additlon has been inspected for the measures required
<br /> by the 1991 Washingt n State Energy Code(WSEC), that!t!s In subsfantial compliance
<br /> wifh he W C,an t at th EC checklist for this building 's on file.
<br /> I � C
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<br /> � Signamre of Building cial or Authorized Representauve Date
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<br /> � Return canary copy to the sorvicing electric utility to irigger WSEC compliance payment
<br /> Retutn white copy to•Kathleen Skaar Washington State [nerqy Otlice P.O.Box 43165 Olympia,WA 985043165 �2�92
<br /> WSEO-Whi�e Copy Utility/Owrrer-Canary Copy Jurisdiction-Pink Copy
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