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WST TE Gi�f�J <br />coo� <br />�oGRan� <br />Building Record <br />CLASSIFICATION <br />(p.'oase check one) <br />❑ New Building G Addition over 500 sq. tt. <br />JuriSdic�ion'.______ __ ___._' <br />pleasetl�eckone: 0 Clty ❑CoUnty <br />- CO <br />A. Sitelnformetion _ _ <br />Address <br />City --. _-. -.- .-_Z�P___—:..—�- <br />Assessor's PropeRy_Tax p(o. arracn �ega� des � tiorr :_ <br />ServiCingElec�ncU�ility__ ___ _ . _ ___�_ <br />C. If Single Family, Zeru Lol Line or <br />Planned Unit Development <br />Tolal Condilionetl Floor Area � _ sq. it. <br />Seconc Dupiex Unit _ _ _ _ _sq. it. <br />A. PrimerySpeceHealType <br />(chxk one) <br />❑ Eleciric Baseboard <br />I� Electric Furnace <br />❑ Elec�ric Heat Puinp <br />❑ Olher f'Walybelowl <br />COMPLIANCE <br />WSEC Campliance Method <br />❑ Prescriptive Pa�h <br />❑ Component Pedormance <br />❑ Sys�emAnalysi5 <br />Aftachment B <br />ws�o co�a�a_ <br />(plraso check one) <br />❑S�ngleFamily ❑Duplez <br />❑ IAultilamily ❑Zero Lot Line Home <br />❑ Planned Unit Development _ _ _ _ _ _ , _ _ _ _ <br />Permit # <br />" _ __ _- . '_' _ <br />FiIC ID q{Atl�Heren! Irom Pe�mil Nj <br />'IDN z$ <br />B. Owner Inlormation <br />Ow11Bl�amnr af Gme ol wreluYon reoc��95 uliMN Wl'^�enJ _ <br />Company . _ _.---_ _'._ .. <br />Address <br />Ciry _ _ . . .�.._ Sta�e , �' ZiP�_- - <br />Phone __{_ � f__�� <br />Federal ID# or SSN <br />D. II MuIlllnmily (R-1) <br />Total q o� Buildings <br />Total k of Unils <br />Tolal sq. ft. (optional) _ <br />!!CAT SOUBCE <br />8. Back•Up Space Heat Trpe <br />(optlonal, check ell lhat app y) <br />❑ None <br />❑ wood <br />❑ EleciricBaseboard <br />❑ Olher Iwenty oelow) <br />C. Wo�er Heat Type <br />(apllonel, chack onc) <br />❑ Elecu�r, <br />❑ Gas <br />❑ Other�spearyneim�i <br />INSPECTION/ENFORCEMENT <br />Date oi Permit Application <br />Date Building Permit Is ued ___ ___ _ <br />Date of Insulation Inspection _ __ _ _ __ _ <br />Date ol Final Inspec�ion <br />I hrre6y certlly fhaf fhls bullding oraddlllon hes been lnspecled !or fhe measures requlred <br />by fhe 1991 Weshingfon Sfafe Energy Cade �WSEC), fhaf If Is In subsfanfial comp(lance <br />wifh fhe WSEC, and fhat fhe W55� ehecklist !o� fhis buflding is on lile. <br />S�pamuro o' EluiO.ng OlLcial or ANhorizetl Bep�asenlatrvo Oa!a <br />RMum whlie copyto: Hathlecn Skaar. Washin9ion Slaie Ene�,y Olf¢a 809 Legion Way SE, FA-11. Olympia. WA 98504�1211 <br />lt5r.0 Itn.,rLopy u;:try'O�..n,•r Can:iryGOPY JunsumFon-PmkCoOY 6�91 <br />