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WA.�SHI�NGTON `i �"1
<br /> � Building Record ���# �"` B
<br /> �oGRan�
<br /> � ' �� �� " t��►'ti'�t �, -� ���,��
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<br /> (please check one) ( I aso check one)
<br /> �New Bu(Iding �AddNion over 500 sq.tt. �S:ngle �amily ❑Duplex
<br /> Jurisdiction: ��� uf /�/Pi'! � _ ❑Multifart:ily ❑Zero Lot Line Home
<br /> ❑Planned Unit Develo ment
<br /> prease cneck one: �CitV ❑CountY Permit# :�=�//
<br /> FI�B ID#(ildi!lerenf Irom PermitlQ
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<br /> �� �4's� � � ��'�tY'��Y��,{�a'���`�'as'�'�: .:.s. 34'�,s'`. � P
<br /> A. Site Information B. Owner Information
<br /> AddrBSS �J�//�/ �(,/i'„i,��; ,(l � i OWnOf lamerstfimealconswcfionraceivesuh'IMpavmenU
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<br /> City �J,=�- � Zip 1, . ''-% Com an 'i� ��_, ' l
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<br /> ASSeSsoYSPropertyTax-�1 (orattachl aldescntion�: Add�BSS �/[�y�/ ',i/✓v> > ,l,� ,,_x_
<br /> ��� / l J-l- l<i,(P,� � l K C(t �„!�1-f StateuUf Zip J%1,-�U?
<br /> Servicinp Electric Utility �i1 0 ! "��_(1 Phone (.�OG� ) „i'�� - (�00`.-
<br /> Federal ID#or SSN
<br /> C. If Single Family,Zero Lot Line or D. If Multifamily(R-t)
<br /> Planned Unit Development Total#of Buildings
<br /> Total Conditioned Floor Area I 1 1 2 sq. ft. Total#of Units
<br /> Second Duplex Unit sq. ft. Total sq. ft. (optional)
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<br /> A. Prfmary Space Heat Type B. Back-Up Space Heat Type C. Water Heat Type
<br /> (eheck one) (eheek all that apply) (eheek one)
<br /> ❑ Electric Baseboard None Electric
<br /> � Electric Wall Heater ❑ Wood ❑ Gas
<br /> ❑ Electric Fumace ❑ Electric Baseboard ❑ Other�speciiybeiow�
<br /> ❑ Electric Heat Pump ❑ Other/sped�yee�ow)
<br /> ❑ Other
<br /> � _` � �_� .' � . � CIiMPLiA1�E � � � �� ������� � �1NSPECTIf�UENFOAC�M�N'�`��: � ._
<br /> This bullding meets the WSFC Compl(ance Method Date of Permit Application .�j� ��
<br /> �Electric rescriptive Path Date Building Permit Issued �3- 7� �
<br /> ❑ Other Fuels Componenl Performance Date of Insulation Ins ection � -' '�/
<br /> requirements of the WSEC. ❑ System Analysis Date of Final Inspection - � -y�
<br /> � I hereby certi/y that thls building or addltion has been lnspected/or the measures requlred
<br /> � by the 1991 Washington State Energy Code(WSEC), that!t Is!n substantla/compllanre
<br /> ���with the WSEC,and that the WSEC checkllst lor th/s bullding!s on Ille.
<br /> � _� i • � .
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<br /> Signature of Puilding 011icial or Authorized Representativo 'Datn
<br /> Return white copy to: Kathleen Skaar, Washington State Energy Office, 809 Legion lNav SE, FA-71, Olympia,WA 98504-1211
<br /> tYSEO-While Copy Ufility/Owner-Canary Copy Jurisdiction Pink Copy
<br /> 7-92
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