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t7�� <br />��x <br />>Hxf~/� <br />y x ��-+ <br />K O <br />H �1 <br />'��tl y � <br />H <br />x <br />� Hl7 <br />H �, g <br />C�J Y (q� <br />9 H [�1 <br />4 <br />t HH <br />g �' <br />oC ty � <br />Cj7 � Cr+1 <br />HON <br />'�� <br />�. ,�� <br />1 S � • <br />�,�_� �,. <br />�� �� <br />ai � <br />..� . <br />��i-z..:: z.r- <br />f~`� <br />Building Record <br />(please cY.=ck ane) <br />� New Building ❑ Addition over 500 sq. tt. <br />Jurisdiction: _____ _i � __ <br />pleasa check one: 0 Clty ❑ COUMy <br />/' ' <br />wSFA Contract # <br />p(�,;rnent B <br />h <br />(please check one) <br />� Single Family � Duplex <br />❑ Multifamily ❑ 7_ero l.o; Line Home <br />❑ Pianned Unit Deve!opment <br />Permit # � <br />File ID #{i! dillerent fron Yarmrt . _ __ <br />��: _. - rn': � T "�-^- r�q <br />1..L�f.�IM 1 ��� <br />�l T . � ` t ' rv <br />!� F...i � 4'.d il ��i-`-,� �\� , .. '__. —__� <br />iiirii. <br />A. Site Informat�on ___ ___ <br />Address �� '� � � �� I f � v c: <br />CItY r • ' Zlp .:�. . r_ <br />ASSBSsor'S Property T8x # or atlach legal deschplfon�` <br />Servicinp Electric Utility_� _, _ _ <br />C. If Single Family, Zero Lot Line or <br />Planned Unit Development _ __ <br />Total Canditioned Floor Area sq. (L_ <br />Second Duplex Unit sg_ft. <br />B. Owner Inf�. rmntfo�i <br />Owner /amer at 6mr _� mrrstn�ctlon recei�s �tluNpaymenU <br />� �' -- <br />Company _ _ <br />Address � � ' <br />. ..1� StdtB . ��' ZiP � <br />City_ �',-, <br />Phone ('- ) _ � — <br />rederal ID# or SSN __ _ ___ <br />D. If Multifamily (R-1) <br />Total # of Buildings <br />Total t! o( Units <br />7otal sq. ft. (opJional)___ __ ' � � (J <br />� ," '� IEAT SIIIIRCE .,'� �,�, � <br />(� '� A. Primery Space Heat Type <br />^w � (cneck ons) <br />� Electric Baseboard <br />❑ Electric Furnace <br />"` � ❑ Electric Heat Pump <br />❑ Other (spea�y be�ow) <br />! i 1 <br />I;O�LJANCE <br />^ -- WSEC Compliance Method <br />� Presc�iptive Path <br />� 1= ❑ Component Performance <br />❑ System Analysis <br />B. Back-Up Space Heat 7ype C. Water Heet Type <br />(opNs�� d, eheek all fhaf apply) (opflonal, eheck oneJ <br />❑ None ❑ Electric <br />❑ Wood ❑ Gas <br />❑ Electrc Baseboard ❑ Other �spec�• <br />❑ Olhf:f �specity belowl _ <br />INSPECflONIEqFOM�MpR <br />Date of Permit Application <br />Date Building Permit issued <br />Date of Insulation Inspection <br />Date ot Final Inspection _ __ <br />I hereby certlty that thls bullding or addiffon has been lnspected /or the measures requlred <br />by the 1991 Washington State Energy Code (WSEC), fhat !t !s !n su6stanNal compllance <br />with the WSEC, and that the WSEC checklist !or this building Is on lile. <br />----- -- -- — — ---- -- <br />SignaWre ol �uading Oflicial or Aulhorizod Representative Date <br />Return white copy to: Kathleen Skaar, Washingi�n State Energy Oflice, 809 Legion Way SE, FA-11, Olympia, WA 98504-1211 <br />WSEO-WhifeCapy Utiliry/OwnerCanaryCopy Jwisdidion-PinkCopy 6_g� <br />