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<br /> W� Building Record WSEOCa��ct# A� B
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<br /> '(p ase check one� (paese cFrec'r,one)
<br /> �New �� 0� �� �Sin le Famil ❑Duplex
<br /> Build' g ❑Add' ion over SO�q.ft. ❑Mukitamily ❑Zero Lot�ine Home
<br /> Jurisdiction• i
<br /> ❑Planned Unit Development
<br /> pleasacFreckone CIIY ❑COut1N
<br /> Permit# �'�.�23
<br /> FI@ ID#(i/difterenf tram Permit A1
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<br /> A. SNe Information B. �wner Infortnat(on
<br /> Address � Owner (owneratOmeolcon^bucaanrecei�su61'M�I+�aM) —
<br /> Com an P/1 ��' � J�
<br /> C• Zi �03 e u, � �p
<br /> Address
<br /> Assessor's Pro ert i Tax# ar.att.ach leqal descnptlon): CII State + Z� S
<br /> Af': I 5��-9.�' Phone ( �OCv 1 /os�/ -a 73,Z_
<br /> Servicinq Electric UtilitY
<br /> E. If Multifamily(R=i)
<br /> C. if Singie Family,Zero Lot Line or D. Duplex Sq ft Total#of Buildings
<br /> Planned Unit Development Frst Duptex Unit
<br /> Total Conditioned Ftoor Area s .ft. Second Du lex Unit
<br /> , g, Total#of Units
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<br /> �. ez i F. � .' a�,� � '4. -� $ �1��WNM. ....�.'�"F� ...�i��.'...:< �C��. 35'a.,c..,x...x h. .,<,P :.
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<br /> B. Secondarz Space Heat Type C. Water Heat Type
<br /> A. Primary Space Heat Type ��ry�kall t atapply) (eheckone)
<br /> (cneckone) — Eledric
<br /> ❑ Electric Baseboard None
<br /> � W�� ❑ Gas
<br /> �Electric Wall Heater ❑ pther�sPeGtyneiow)
<br /> Electric Furnace ❑ Electric Baseboard
<br /> ❑ Electric Heat Pump ❑ Olher(specity beiow�
<br /> ❑ Other ,np(1� d<.,:;�.�� e�`��,
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<br /> �lo�Hul Pu�rp OnN)
<br /> WSEC Compliance Method This building meets the Date of PermK Application - 2-
<br /> � eleciric Date Buildinq Permit Issued //1 -_ � —
<br /> � Prescriptive Path Date ot Insulation Inspection �^ l0—9 5
<br /> ❑ Component Performance ❑ other fuels Date ot Final Inspection � 2 7 -9S
<br /> ❑ System Analysis - �q���ments af the WSEC.
<br /> 1 hereby certify that fhis buildina or additlon has been inspected for the measures required
<br /> by the 1991 Washingtan State Energy Code(WSEC), fhat it is in substantial compliance
<br /> with the WSEC, an�hat he SEC c ecklist for this building is on file. �
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<br /> Signatura of Building OMcia or Authorized Repre�eMative
<br /> Date
<br /> Retura eanary copy to the servicing electric utiiiry to tric�ger WSEC compliance payment �2 92
<br /> Return while co y to:Kathleen Skaar,Washington Stale Energ Olfice, P.O.Box 43165,Olym �Un WAr9�85��3��y
<br /> WSEO-Whire Copy Utility/Ovmer-Canary CoPY
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