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�� <br />. � <br />�: M <br />� ,��� � I � , � I I �.� I 1. <br />� � <br />� �. � � <br />���2C2�� ...r' _.F, t .i i + a � .` `� ' a„ . J 1� . . o . <br />�please check oneJ <br />New Buildin /❑ AdditioGn o'ver 50 sq. tt. <br />Jurisdiction: Cc.� r�J �,/ <br />0 ' <br />please check one: CitY ❑ COuntV <br />(please check oneJ <br />�Single Family ❑ Duplex <br />Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Develo ment <br />Permit# 1.�i���� _ <br />-�_ <br />Fl le I D#(if diNerent Irom Permit A� <br />1 ,-=,x P s-t :E �„, 4 ��: ' I <br />v .- <br />� .; , <br />, , <br />. ri . , <br />, . : <br />,_ <br />, . <br />a. <br />:.s. , t ,.. ,;.� r .+, ._,�k., r . > .. . , . <br />A. Stte Informetion <br />Address D/D 1/('� <br />c�ri ✓�� z�p , 2Q__ <br />ASS@55or'SPro e T2X�r orattachl aldescri tion : _ <br />�SP � �3-C'+�- /./- �S <br />Servicinq Electric Utility Srn p%'p �G! !� <br />C. If Single Pamily, 2ero Lot Line or D. Duplex <br />Planned Unit Development First Duple� Unit <br />B. Owner Iniormation <br />Owner ownerar6 eo�cons ' leceivesuh7' ern <br />l/ � / <<.a._ <br />Comoanv �T <br />Address /� ! ox �3CtL� <br />CiN �/nAn�}- StateLt/f%' Zip ���3 <br />Phone ( �Ya 1 �aT-!�7o"u� <br />E. If Multifai <br />ft. Total # of <br />.., .Sc.� ],'.S..t} �'��.�.a�. � � .Y .i:5� � <br />l�., <br />A. Primary Space Heet Type <br />(eheck one) <br />❑ Electric Baseboard <br />� Electric Wall Heater <br />❑ Electric Furnace <br />❑ Electric Heat Pump <br />❑ Other � <br />B. Secondar�rSpaceHeatType <br />(check aU t aP app/y) <br />� None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other(speci/ybelaw) <br />C. Water Heat Type <br />(eheck one) <br />� Electric <br />❑ Gas <br />❑ Olher (specilybelaw) <br />par Heat PumpOnry) <br />WSEC Compliance Method This bullding meets the Date of Permit Application ,/�,�- gr <br />� Prescriptive Path � electric Date Buildinq Permit Issued �� -�ff- QS�" <br />❑ Component Pertormance ❑ other fuels Date of Insulation Ins ection - - <br />❑ System Analysi^, requirements of the WSEC. Date ot Final Inspection 12. -7-q <br />1 hereby certl/y that thfs bu/lding or addit/on hes been Inspected lor the measures requfred <br />}Y the 1991 Wa .rington State Eneryy Code (WSEC), fhet It !s !n substant/al compllance <br />�/�lt� the �nECp, and at the INSEC checkllst lor thfs bu/ld/ng Is on flle./ 2/n /S S <br />�/ � [ <br />Ofliclai or Authorized Representative <br />Date <br />Return canary copy to the servicing electric utility to trigger WSEC compliance payment <br />Relurn white copy to: Kathieen Skaar, Washington State Energy Office, P.O. Box 43165, Olympia, WA 98504-3165 <br />WSEO - White Copy Ufility/Owner - Canary Copy Jurisdiction - Pink Copy <br />12-92 <br />