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WNGTON g <br />Building Record —# <br />RMW <br />(please check one) <br />lew Bulldlrtg , ❑ Addition over 500 sq. ft. <br />Jurisdiction• 1 � �� <br />please check one: City ❑ County <br />A. Site Information <br />Address --;'/A0L Rd�dn <br />City �,-Vpe ZZi <br />Assessor's Pro Tax or attach al dose lion <br />•s n �i - Oa - <br />Servicino Electric Utility U <br />C. If Single Family, Zero Lot Line or D. Dupl <br />Planned Unit Development I First <br />A. Primary Space Heat Type <br />(check ono) <br />❑ <br />Electric Baseboard <br />Electric Wall Heater <br />❑ <br />Electric Furnace <br />❑ <br />Electric Heat Pump <br />❑ <br />Other <br />(please check one) <br />❑ Single Family ❑ Duplex <br />dZ Multifamily ❑ Zero Lot Line he ne <br />❑ Planned UfA Developmtot- <br />Permit # gg4p-77 <br />File ID # (if drHe ant hom Permk! l <br />B. Owner Information <br />Owner owner f e of construch in recakas u " rent <br />Company <br />Address O DX <br />city�`2te State zip�3 <br />Phone 33 <br />r <br />E. If Muitifal <br />Unit sq. ft. I Total # of <br />B. Secondary Space Heat TYPO <br />(eheek 11 t appty) <br />LX None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other (specify below) <br />C. Water Heat Type <br />(check one) _ <br />14 Electric <br />❑ Gas <br />❑ Other (specify below) <br />(for Hut Pump 0m•) <br />WSEC Compliance Method This building meets the Date of Permit Application - a <br />Date Building Permit Issued <br />❑ Prescriptive Path 64 electric Date of Insulation Inspection <br />J• Component Perfor-nance ❑ other fuels Date of Final Inspection <br />r 1 Svstem Analysis requirements of the WSEC. <br />1 hes eby certlfy that this building or addition has been Inspected for the measures required <br />y the 1991 Washingt n State Energy Code (WSEC), that It Is In substantial compliance <br />the WSEC, and t t the WSEC checklist for this bulldln Is on lie. <br />37 9 <br />Signature wilding Official or Authorized Representative Date <br />Return canary copy to me servicing enjUtnc Uknl,r 1V O1aa- ••" "'r••-••-- r- ----- <br />Return white copy to: Kathleen Skaar, Washington State Energy Office, P.O. Box 43165, Olympia, WA 98504.3165 <br />WSEO - While Copy UffliWwner - Canary Copy Jurisdiction - Pink Copy <br />72-92 <br />