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W��Na1DN �G �6-9y <br /> �• Building Record ,�o�#A"��"` e <br /> �oG�w, <br /> 4 . <br /> (p�ease check one) (p� aso check one) <br /> �New BuildiAn 0 Addt�lon"o've�r 500 sq.ft. �Single Family ❑Dupiex <br /> Jurisdiction: C: I O �J�T ❑Multifamily ❑Zero Lot Line Home <br /> ❑Planned Uni Develo ment <br /> please check one: L CiN ❑CoUnN P2rtnit# o�73� <br /> � FilO ID#(il diNerent/rom Permit A1 <br /> � <br /> A. Site In(ormation B. Owner Iniormation <br /> Address /O_ OS ,C/ i OWI1ef (ameratNmeolowrs6ucponrecelvesu6TMpavmm0 <br /> CIfV � �/_Q/rQ 21P �PJ� COrt1 an AqLP.8 /�_ <br /> � � �ASS@S�SOf'S Pf0 B�T2X#(oraBach lepal descnptioN: Address .� � �/ <br /> --�-g-� N Sp �aoa -sa- 9i c�ri r�e/a„�C scate z� <br /> Servicinq Electric Utilitv �y,o /`�U�1 Phone ( ) <br /> Federal ID#or SSN <br /> C. If Singie Family,Zero Lot Line or D. If MultifNmliy(R-1) <br /> Planned Unit Development � Total#of Buildings <br /> Total Conditioned Floor Area /5ad sq ft Total#of Units <br /> Second Duolex Unit sq ft Total sq.ft. (optional) <br /> A. Primary Space Heat Type 6. eack-Up Space Heat Type C. Water Heat Type <br /> (check one) (chaek atl fhat app/y) (check onaJ <br /> ❑ Electric Baseboard None Electric <br /> ❑ Electric Wail Heater ❑ Wood ❑ Gas <br /> • ❑ Electric Furnace ❑ �lectric Baseboard ❑ Olh@f(specilybelow) <br /> ❑ Electric Heat Pump ❑ OSh2f(specilybelow) <br /> ❑ Other � <br /> . _. �Y ,___ __..L.�.. _ __ _____ __. <br /> This buildfng meets the WSEC Complfance Method Date of Permit Application /- - 9 <br /> �Electric ❑ Prescriptive Path Date Building Permit Issued a-/ 9.� <br /> ❑ Other Fuels ❑ Component PeAormance Date of Insuiation Inspection .�-�9�— <br /> requirements of the WSEC. ❑ System Analysis Date of Final Inspection '"L��d."LQr�- <br /> I hereby cerilfy that thls bullding or addition has been inspected for the measures�=qulred <br /> by the Y991 ashington State Energy Code(WSEC), that!t!s in substandal compllt�nr.e <br /> h the C, an t t the WSEC checkllst for thls buildin /ile. <br /> � <br /> ignatura of B ilAing iciai or Authorized Represenlative •. Date <br /> Return whfte copy to: Kathleen Skaar, Washington State Encrc�y Office, 809 Legion Way SE, FA-1 t, Olympia WA 9850 -1211 <br /> ' WSEO-While Copy Ufiliry/Owner•Canary Copy Jurisdicti -Pink Copy <br /> 7•92 <br />