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1 ' .� � <br />] r_14 <br />] Y � <br />F Fi 1 <br />'r' � � ' <br />P. s,� <br />,. ..y <br />Building Record <br />(please check one) <br />❑ New Buildl /�Ad tlon over 500 sq. tt. <br />Jurisdiction: l-/�� ����lGf�' <br />ease heck ore Clly ❑ COUoN <br />�c�noN <br />YY5E0 CantractN <br />Attadrnent B <br />(please check one) <br />[$Single Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development _ <br />Permit� 3(09(04 <br />File ID # �il diNerenf !rom Permit A1_ <br />� i.,' ] I �'. .y 1.',— <br />A. Site Information __. _ <br />Addross�.�0� /q�Gn/� V� <br />C��✓P�t Zi�__ — <br />Assessor S Pro e�rty Tax #(or attach legal descdptian) : <br />Servicing Electric Utility o C u — <br />B. Owner Information <br />OW nef (avner at nimr nl cJrshiwYion reoeivas ud � ymenq <br />�� e SS 'L �� A e�l. — <br />Comp� '� <br />Address �� /?.� S�— <br />C�it'�2�- Sv ��e SlalB l� ZiP ��a 70 <br />Phone ( ao� ) �Sa_ -� 7� � <br />Federal IDq or SSN 534 - 3- 27 7 2 _ <br />C. If Single Family, Zero Lot Une or D. If Multifamily (R-1) <br />Planned UNt Development __ Total # of Buildings <br />Total_# of Units <br />Total Conditioned Floor Area ____ __ _. 5q-ft.- Total_s ft. o tional <br />Second Duplex Unit __________—. _S4� �t _ 9,—l� � <br />NEAT SOIIRCE <br />A. Primery Space Heat Type <br />(eheek ons) _ __ <br />� Electric Baseboard <br />❑ ElectricF�imas� <br />❑ Electric H�at Pump <br />❑ Other (spearyce�owJ <br />r� � <br />WSEC Compliance Method <br />❑ Prescriptive Path <br />� Component Performance <br />❑ System Analysis <br />B. Beck-Up Space HeatType <br />(optlonal, cheek all thef apply) <br />❑ Nnne <br />❑ Wood <br />❑ Eleclric Baseboard <br />❑ Other (spec�N oebw) <br />C, Water Heat Type <br />lopflonsl, eheck onel <br />❑ Electric <br />❑ Gas <br />❑ Other (speciry be�ow, <br />Date of Permit Application _- S 9p2 __ <br />Date Buiiding Permit Issued �p�a--�i �-- <br />Date of Insulation Inspection /� •.�7- 9� <br />Date of Final In�ectio�,,2 �' �l 'i3 <br />1 hereby certity fhat this bullding or eddltion has been lnspected for the measures requirea <br />6y the 1991 Weshfngton State Energy Code (WSEC), that if !s !n substantlal campllance <br />wlth the WSEC, and thet the WSEC checklist /or thls building ls on flle. <br />- <br />z-�=93-- <br />Signatwe ol Building Ofticial or Authorizetl Representative <br />Date <br />Return wMte copy lo: Kathleen Skaar. Washington State Energy Otfice, 809 Leg'on Way SE, FA-11. Olympia,_WA_98504-1211 <br />- - Utilit Owner-CanaryCopy Jwisdiction•PinkCopy 6-91 <br />- . �„orn _ uinao r �� y; <br />