Laserfiche WebLink
�n� <br />��x <br />a H <br />>yti <br />C <br />H H <br />�H� <br />� C�/IH <br />�i o �r <br />OHd <br />H Ct]O <br />4)� C� <br />H C <br />zy� <br />�HH <br />OyH <br />Cq] t7 f/� <br />lT1�M <br />Z �? V� <br />�; o cn <br />WASHINGTON <br />CODE <br />PROGRA1v1 <br />Building Record <br />CLASSIFICATION <br />(please check one) , <br />❑ New Bullding �Addition over 500 sq. ft. <br />Jurisdiclion: — - <br />pleasecheckone� ❑ Cily ❑CwntV __ <br />AttacMient B <br />!NSEO Corttract#_ <br />(please checA' one) <br />� Single Family ❑ Duplex <br />❑ Multi(amily ❑ Zero Lot Line Home <br />❑ Planr�ed Unit Developmenf <br />Permit # <br />FiIB ID # IildBlere.nllramPermitd0 <br />COIdSTRUC'fIUN__ � � ��� `�`� <br />A. Site In(ormatlon <br />Address _ �'-� l)(0 � �'i,��� r — <br />— -� � <br />CitY I' Ji' ��� '� 7 v <br />Assessor'S Prope� Tax #(or auach legal descri tion_ <br />Se{vicing Electric U�i�______ ___ _—._ _. - <br />B. Owner Intormation <br />OwnOt owneratfimoolwnstructionrecervesutilMpaymen0 <br />�..��/ ' '�� — <br />Companv ' a � � I I f� � S <br />Address SS Z UC� ' " - <br />piy _„�,�_�,.,,s_h .State's�,'� Zi Zs «iG <br />Phone l �' �'� ) `/- x— 7ic h.' <br />Federal ID# or SSN <br />�� <br />C. If Sfngle Family, Zero Lot Line or D. If Multitamlly (R•1) _ <br />� � Planned Unit Development Total # of Buildings <br />Total Conditioned Floor Area ___ _ sq. ft Total i! of Units _ <br />Second Duplex Unit _ ___ sq. ft. Total sq. fl. (optinnal) ___ ___ -- <br />— -- <br />I` � NEAT SOURCE _ _ _ _ _ _ -- --------- <br />D" " <br />�.. , � <br />G"� <br />.,,� �d <br />R � j <br />A, Primary Space Heat Type <br />(check one) <br />� Electric Baseboard <br />❑ Electric Wall Heater <br />❑ Eleclric Furnace <br />❑ Eleciric Heat Pump <br />❑ Otlter _ <br />COMPLIANCE <br />B. Back-UP SE>ace HeatType <br />(check nl fhaf applyJ <br />❑ None <br />❑ Wood <br />❑ Eleciric Baseboard <br />❑ Ofher (specitybelow) <br />C. Water Heat Type <br />(check one) _ _ <br />❑ EleCtriC <br />❑ Gas <br />❑ Other�spedrybeio��-I <br />IPISPECTION/ENFORCEMENT _ _ <br />This building meets lhe WSEC Compllance Melhod Date of Permil Appllcalion _� .. <br />❑ Eleciric L] Prescriptive Path Date Building Permit Issued -1 _! �. <br />❑ Other Fue1s � Component Pertormance Date of Insulatio�: Inspection '; ' . <br />Date of Final Ins�ection _ _ _ _ _.r-! ���._ <br />requirements of lhe WSEC. ❑ System Analysis - - <br />1 hereby cert!ly thaf thls building or addition has been inspected lor the measures requlred <br />by fhe 1991 Washington Stale Energy Code (WSEC), that it Is !n subsfanflal compllan�e <br />wifh the WSEC, and fhat the WSEC checklist !or fhls 6uilding is an lile. <br />Sipnalure ol Bwlding 0117cial or AuU�on: ed fiepreson�a�ive Da!e <br />Re�um whi�e copy to: K2lhleen Skaar, Washington State Energy Oflice, 809 Legion Way SE. FA-11, Olymoia. WA 98504-1211 <br />645E0 � WYme Copy Uldily.O�mer - Canary Copy Junsdic(ion - Pink Copy <br />7-�2 <br />