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,,1��n • <br />��''''- <br />��-�• � <br />�� � <br />...� �• . <br />r■: <br />Building Record <br />( check one) . <br />New Building AddRion o,r 500 sq. tt. <br />Jurisdictb�: <br />�I.�J.^ �Y �VQV1111 <br />� <br />, <br />• . . : ' ���� .� i!1.� <br />_./!/_ � � _� <br />,. ..: <br />.�' .. � ii�: <br />. : ._.��T.��:�, �!11 <br />C. M Singls Famlly, Zero Lot Line or D. Dupl <br />planned UnN DevebpmeM Flrst <br />A. Primary Space Heat Type <br />rek om) <br />Electric Baseboard . <br />❑ Electric Walt Heater <br />❑ Electric Fumace <br />❑ Electric Heat Pump <br />❑ Other _ <br />Unit <br />VYSEO Onntrar.i M <br />(pr ehack one) <br />Single Family ❑ Duplex <br />❑ Muftifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Develo meM <br />Permk M ��. <br />Fle ID If (Ndxkronr�rom Ferm8A1 <br />B, Owne� Information <br />A�d B <br />B. ��Seca �er�rit�i�Y) Heet Type <br />❑ NOne <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Olher�(specirybelow) <br />E. Ii Multihu <br />ft. Total N of <br />C. WaterHeat'fyps <br />(di�ck on�J <br />Electric <br />❑ Gas <br />� ane� �s�pty�bW� <br />� , . . �w H..� au�v a�M <br />WSEC Compliance Method This bulldtng meets the Date of Permit App��cation //- f-9...3 . <br />�Prescriptive Paih ❑ eiectric Date Buildina Permit Issued /-�' <br />❑ Component Performance ❑ other iuels Date ot insulation Inspection i-1 5- 9'f <br />❑ System Analysis requiroments of the WSEC. Date of Rnal Inspection �lj-3/ —R H <br />1 harieby cerfHy thet th►s building or addffion has been lnspected /or fhe measures requ�� <br />y the 1991 Washington State EnerQy Code (WSEC), thaf N is !n substantlal compliance <br />fhe EC, a fhat fhe WSEC checkllst for fhls buildfng fs o 81e. <br />'� <br />Buildna Offldal or Authorized Representetiva Date <br />( • <br />Return canary copy to the servicing electric utllity to trigger WSEC compliance payment �Z 9Z <br />qeturn whke copy to• Kathleen Skaar, Washington State Enargy Olfice, P.O. Box 43165 Oiympia WA 98504-3165 <br />WSEO - Whiro C� py Unliry/Owr�er • Canary Copy JunsdicNon - Plnk CoPY <br />