Laserfiche WebLink
� <br />��� <br />aHy <br />y � r-�i <br />� H� <br />"�� H'i1 <br />q1 N <br />x <br />��o <br />�/��g <br />y� Y � <br />�H� <br />� F+ H <br />N <br />c❑� C y <br />t�1 � M <br />HOy <br />. • <br />],r_t4 <br />,�, • . <br />..� � <br />..� •. <br />;, : <br />(pleaso check one) <br />0 New Buflding <br />Jurisdiction: _ <br />,.._, <br />Building Record <br />❑ Addition over 500 sq. tt. <br />please check one: � CitV ❑ COtlf1[y _ <br />, <br />A. Site Information <br />Address ------- <br />Citv �— <br />Assessor's Pro � Tax #_ or arracn iegai descrrQao�__ _ <br />��------ --- <br />Servicing Electric UtilitY _ — <br />C. If Single Family, Zero Lot Line or <br />Planned Unit Dovelopment <br />Total Conditioned Floor Area Sq n. <br />��. <br />p�aqment B <br />(please check one) <br />❑ Single Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Ptanned Unit Development _ -- <br />Permit # _ ' <br />File ID il (i! diNerent Imm Perznit A� <br />,<:,,.r�;�-, <br />fION �,�'.� �, <br />g, Owner Information _ <br />�Wf18f jox'ne� at Gme of mn5fnufan rc��es UGlifl'PaYm��— <br />Company __ ---- -- <br />Address __-- ---- <br />�� -. � , — State ' Zip <br />) ' '�� . <br />Phone ( :__ <br />Federal ID# or SSN <br />D. If Multifamily (R-1) <br />Total # of Buildings — <br />Total #_ot_Units <br />Total sq. tt. {optionap , f — <br />�, � Second Duplex Umt _ -- i� <br />..4i?L ��+il'tYr . �a <br />F NEATSOIIIN� "9" :�1 <br />1 1 ,. _ <br />L`4 �+. s.: ' T <br />`� �� p, ph�ryS paee HeetType <br />"� __ — <br />❑ Electric Baseboard <br />❑ Electric Furnace <br />� �► ❑ Electric He�t Pump <br />❑ Olher (speary eeirn.9 <br />!11 <br />�. <br />;; . _ � <br />WSEC Compliance Method <br />❑ Prescriptive Path <br />❑ Component Performance <br />❑ System Analysis <br />9. Back-Up Space Heat Type <br />(opflonal, ehsek ell Maf apply) _ <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Olhef (soeclty below) <br />C. �epuonsl{ check �) <br />❑ EIQCtfIC <br />❑ Gas <br />❑ Other (speaN below) <br />p�gp��CT1011lENFOIN,EM�N'T_ <br />L'a�c o� F armit Application _ _____ .__ <br />p�,�� tt� ,iin., �armit Issued <br />D�'e ol �.����iation Inspect_ _._ �o��._— <br />Data of F �3� Inspection __ _ ___ <br />1 hereby certlty that thls bullding or addlflon has been lnspected lor fhe meaeures requlred <br />by fhe 1991 Washington Stete Energy Code (WSEC), that it !s in aubetantial compllance <br />wifh fhe WSEC, and that fhe WSEC checklis� /or thls bullding fs on lile. <br />___-. ..---_- ._— - - - Dale <br />— ._. �...�....., rorNal nr Aulhoiized Repfe5eN01ivo � <br />Signai <br />FA-11 Olympia VJA 98504-1211 <br />Return white copy to: Kathleen Skaar. Washington State Encr9y Office. 809 Legion Way SE, � �u�;sd�cion � Pink Copy g.g� <br />�� WSEO�WhileCopy Utild�'Owner�CanaryCapy <br />