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►. � <br />� � -. <br />- � -_„ <br />Building Record <br />��aB�aS �,� a�a, <br />LiNew Buildfng Additlon over 500 sq. tt. <br />Jurisdiction: iyi, ��l//�oi7' <br />prease eneck one: �' CiN ❑ CounN <br />A. Site Informatlon <br />Address �73 nllj", / .1 <br />Ci Zio <br />ASSeSSOrS Pfo 2 T8X # or att h/ al destn tion : <br />L -R�— <br />Servicinq Electric Utilitv L in� � //� <br />��# <br />(pleaso check one) <br />0 Single Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />n Planned Unit Development <br />Perm�t# y�1o27 <br />FI8 ID #(ildlHarant Irom Permit b1 <br />8. Owner In'ortnation <br />���� <br />Alfachnent B <br />• � <br />. <br />� <br />. .. �A_1.7. � �v�._ J '� <br />• " a / � / � � i .� �� �Y� <br />_!� i i[_ _ _. � • i �/ <br />, � . <br />-,_ �. <br />C. If Single Family, Zero Lot Line or D. If Multlfamily (R-1) <br />Planned Unit Development Total # of Buildings <br />Total Conditioned Floor Area / sa ft Total # of Units <br />Second Duolsx Unit sq ft Total sq. ft. (optionap <br />A. Primary Space Heat Type <br />(check one) <br />❑ Elechic Baseboard <br />C� Electric Wall Heater <br />❑ Electric Furnace <br />❑ Electric Heat Pump <br />❑ Other <br />B. Back-U� Space Heat Type <br />(cheekal thatapply) <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other(specirybe�ow) <br />C. Water Heat Type <br />(cheek one) <br />��lectric <br />❑ Gas <br />❑ Other (specirybelow) <br />. . 1 � V �. . . . I ( 1 I <br />1 � <br />�,�,���,, ���. :;. �ii.,�;a�.�J4���la.�.,-!=��` <br />This byNtling meets the WS Compliance Method Date of Permit Application �/(o - h <br />�E!ectric Prescriptive Path Date Buiidinq Permit Issued l0 77�� <br />❑ Other Fuels ❑ Component Performance Date of Insutation Inspection ��y _ j� <br />requirements of the WSEC. ❑ System Analysis Date of Final Inspection I 1— Z/— �ri <br />I hereby cerlUy that ' building or addltiorr has been inspecied for !: ra measures requlred <br />the Y991 Wa on St� t?y Energy Code (WSEC), that it !s In substantial compllance <br />� Slie WSEC�n that,;lfe%GVSF�checkllst lor thls build/�aJsvn file_ __ <br />of Buitdin� Oflicial or Authorized Representalive <br />Oate <br />Return white copy to: Kathleen Skaar, Washington Slate Energy Olfice, 809 Legion Way SE FA-11 Olympia WA 98504-1211 <br />� WSEO - Vlhifa Copy Ufility/Owner • Canary Copy Junsdicfion - Pink Copy <br />7�92 <br />