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��� <br />A � x <br />�Hx� <br />yzH <br />K H 'J'�tl <br />�yo�H� <br />OHd <br />��g <br />�1] Y (� <br />ry� <br />HH <br />8y <br />C]Cy <br />��� <br />HOti <br />i <br />"r <br />� � <br />�u�� � <br />►, • � <br />..� .� <br />i� <br />Building Record <br />�� <br />�. 0 ri011b'81.'� � <br />:.i���..�� <br />�3;� � � ���j� � °"'d�?RY`,�}.��:P. <br />(please check one) <br />❑ New Building �Additlon over 500 sq. it. <br />Jurisdiction: /�; :+r ��� r�F.� r iT <br />-r �: <br />please check one: �" CitV ❑ CountV _ <br />(please ch�ck one) <br />❑ Single Family ��'6�plex <br />❑ MuNitamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development <br />PBrmit # �z'7 �la % <br />FIIB ID # (7/diBerentlrom Permit Ni <br />L F.w yi. ryv, �'p-v �tiP'4"`"� iN y^T{ �Y 1 _S9i�` I T�`yl'� Z <br />.� x�z v� � ¢+.7-.fy��� �`:, 1: <br />A. Site Informetion <br />Address / �,'//. �, �k[_/� � <br />CiN �, ,� 1 _�' Zip �%.r%L; <br />Assessor'sProper�,t Tax# orattachlepaldescnpfion): <br />S�i %� /�lV �'' l <br />p EI�— a t�i Utiliy�j,����• ,'' r.[,��• _ <br />C. If Singls Family, Zero Lot Line or <br />Planned Unit Development <br />Total Conditioned Floor Area sq. fl. <br />�,Tiu.pi,�k. Cc1�vLL;��on .. �, ,. , <br />� <br />A. Primary Space Heat Type <br />(eheck one) _ <br />❑ Eleciric Baseboard <br />�Elec[ric Wali Heater <br />❑ Eleclric Furnace <br />❑ Eiectric Heat Pump <br />❑ Other <br />B. Owner Infortnatlon <br />Owner awr�erarMneofaorsm�ctiaireceives <br />, �)lii] _ <br />Com an <br />Address /_ ti�iJ� ' Y� � � <br />� �';Il[hr,�)I�JI� State�l/a Zip '1.9 �i <br />Phone ( ZDi� 1 .'ir'_J-;:�7i_; <br />Federal ID# or SSN <br />D. If Multifamily (R-1) <br />Total # of Buildings <br />Total # of Units <br />Totalsq.fl.(optionaq <br />B. Back-UP Space Heat Type <br />(eMekal fhaNpply)- ---__--- <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other(spec�rynomw) <br />C. Watar Heat Type <br />(eheek om) <br />0' Electric <br />❑ Gas <br />❑ Other /speciry beiowl <br />� _ . , �r��iE ---- � - -.7:i <br />Thls building meets the WSEC Compllence Method Date of Permit Application �� "'�; n9 <br />❑ Electric ❑ Prescriplive Path Date Building_Permit Issued 7- 7 r� �Z- <br />❑ Other Fuels � Component Pedormance Date of Insulation Inspeclion 13--�T-�T t%--/-9' i <br />requlrements oi the WSEC. ❑ System Analysis Date of Final i�spedion �- �- 9 Z_ <br />I hemby certlty thaf fhis bullding or addlNon hes been Inspected /or fhe measures requlred <br />by fhe 1991 Washington State Energy Code (WSEC), thaf It la In substanNal compllan�e <br />:vlth the WSEC, and fhe( fhe WSEC checkllsf /or fhls bullding Is on /lle. <br />• ; ; �_� — -` � � <br />r f/�'--�-=�!/-r� ` ; �L--- . <br />Buildino Oflicial or Authorized Representalivo Data / <br />Return white copy to: Kathleen Skaar, Washington Stale Energy Office, 809 Legion Way SE, FA-11, Olympia, WA 98504-7211 _ <br />WSEO - Whim Copy Ulility/Owner - Canary Copy Jurisdiclion - Pink Copy <br />7�92 <br />