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• � <br /> WASHINGTON <br /> ���-� �uilding Record �o�t# A"�"'� � <br /> ��� <br /> CLASSIf1CQTIQN <br /> (ple.�se check one) (please check one) <br /> �New Building ❑Addition ovar 500 sq. ft. 0 Single Family ❑Duplex <br /> Jurisdiction: _ ❑Multifamily ❑Zero Lo?Line Home <br /> ❑Planned Unit Development <br /> p�ease cneck one: � City ❑County Permit# ��;!� ;�! <br /> FiIB ID#(ir diHerent Irom Permit A9 �. <br /> •. . CON5TRUCTION � <br /> A. Site Information D. Owner Intormation <br /> i\ddress ' � % .-i �, �,i , ) ^, i �� � i/l-' Owner (okxiat6meolconstrucObnreceib2sutilityp3yment� <br /> � � !; � <br /> CitY - ' �' :, ;�i� �,� ZiA � k - Ci� COmpany �� <br /> Assessor's°ropeAY Tax#(orarcacn legal description/: Address i ' �' <br /> ;� i/, 'i:�'�; `r Citv State . :L ZiP �"��S <br /> Servicinq�F.lectric Utilitv � ��� � ����:____ Phone ( ) " =�:� �i� <br /> C. Ii Si.:gle �amily,Zero Lot Line or D. Duplex E. If Multifamiiy(R-1) <br /> Plannsd linit Development First Dupie:, Unit sq. ft. Totai#o(Buildings <br /> Total Co�iditio:ne� Floor Area 't , (Lsg ft. Second Dup:�x Unit s . ft. Total#of Unils <br /> � � 1t�� ` `��'��;��� ..... <br /> A. �rimary Space Heat'fype B. Secordarv Space Heat Type C. Waler Heat Type <br /> (eneckoneJ ,.:heckall tbatapplyJ (checkane) <br /> ❑ Eledric Base�uard :� None ❑ Eledric <br /> [i Elecfric Wal! Ne�;er ❑ Wood ❑ Gas <br /> ❑ Etectric Fumace ❑ Eleciric Baseboard ❑ Other!speci�ybemw� <br /> ❑ Electric ;�eat Pcmp ❑ Other�speciry beiow� _. <br /> ❑ Other <br /> ,', �Ut�PLItlHCE ' 11�SC'�C1'1q�lEN�QEiC�M�NN�' ��'��� <br /> � W� �1oWeaiFoi+vOnly� � . <br /> �VSEC Compliance Method This building meets ihe Date of Permit Application z, '���_ <br /> Datr�Etuildinq Permit Issued �� <br /> [� Prescriptive Pa,h ❑ eleciric ',�= '1 ,� +3 <br /> ❑ Component Pertormance ❑ otherfue!s Dateof Insulation Inspection ll /Z.d � 9_� <br /> ❑ �ystem Analysis requirements of the WSEC. Date of Final Inspection ��/Z 3�.�4- <br /> � 11 ereby certify that this building or addition has been inspected(or the measures required <br /> b�the 199Y Washington Stafe Energ;+Code(WSEC), lhat if is in subsfantial compliance <br /> with tha WSEC, ar,d that the WSEC chec.klist ior this building is on file. <br /> , <br /> __ '�t <br /> Signawfe'ot Eu�lding Oificial or Authorized Representative Date <br /> Return c;aary copy to the servicing elecLic utility to trigger WSEC compliance payment <br /> Return v�hite co�y to:Kathleee Skaar,Washir3ton State Energy Otfice, P.O.Box 43165, Olympia,�VA 96504-3165 �2-9t <br /> WSEO� L�7�itr�Cop�.� Jtility%C'.�^��-Canarv Copy Jurisdicfion-Pink Copy <br /> - ,a.'._' ._.___ _ _—' _ _'_ <br />