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.� � <br />� <br />�u>>�. <br />... , <br />..� .. <br />Building Record ��� <br />�(ple check one) <br />New Build� ❑ Addltio�ver 500 sq. tt. <br />Jurisdiction• 1,�� a'i C✓�-� <br />piease cnerit v" n»v n Cm �nN <br />A. Slte Information <br />Address Ad- <br />-� <br />r•e, / i� a Zip 3�� <br />Assessor's Pro Tax S orar�acA �e aldescr' rion : <br />.c a- lo- <br />Serviana Electric Utility <br />M Sinple Femlly, Zsro Lot Uns or <br />A, Primary Sp�ce Heet Type <br />(eMek onr) <br />❑ Electric Baseboard <br />❑ Electric Wall Heater <br />� Electric Fumace <br />❑ Electric Heat Punip <br />❑ Other <br />WSEC Compllance Method <br />� Prescriptive Path <br />❑ Component Pertarmance <br />❑ System Analysis <br />rwa 5B �n� o�, <br />�3ingle Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Q velo ment <br />Permit # ,� aa-/ <br />Fil@ ID il (ildiHerent from Permit M <br />Owner Informetlon <br />Owner (ownerare'meawnsmic+anraoe7vesueA'rvar�� <br />Com an rcJ � <br />Address / � -S� - � <br />Ci �.n✓i State f� Zi 9 07� <br />Phone ( �(o ) "���/ - ��% <br />s. ss�o„a.�sw� tbee � <br />(ch�ek dl �pPA'1 _ <br />None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ aner r�ry�bW� <br />(hr Fwt vumOOnN) <br />,�T.,h/ls buildlny meets the <br />l� electric <br />❑ other fuels <br />requlremenls ef the WSEC. <br />C. Water Hsat Type <br />(chtck oM) <br />Electric <br />❑ Gas <br />❑ Other (specifybe�ow) <br />Date of Permit Application /� /O 'ri'S <br />Date Buildinq Pertnit Issued .,.'i = �% <br />Date of Insulation Inspection ]' -1 ) -QS <br />Date of Final Inspection y- 30 -9b <br />1 hemby certlly that thls bullding or addltlon has been lnspected for the measures roqulred <br />by the 1991 Washington State Energy Code (WSEC), that !t ts !n substantfal compllance <br />with th� WSkC„a�Id that tfje�j�VSEC checkllat for fhis bullding Is on llle. ^� <br />� <br />Relum canary copy to tF.a servicing electric utiliry to trigger WSEC compliance paymert <br />Return whlte copy to: Kathleen Skaar Washington State Energy OHice, P.O. Box 43165, Olympia, WA 98504•3165 <br />WSEO • Whife Copy Utildy/Owner • Canary Copy Jurisdiction - Pink Capy <br />12-92 <br />