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��� Buildin Record ��# A� B <br /> � g <br /> � <br /> (pleasa check one) � (please check oneJ <br /> (�New Building ❑Addition over 500 sq.ft. �Single Family ❑Duplex <br /> Jurisdiction: ❑Multifamily ❑Zero Lot Line Home <br /> ❑Planned 'Jnit Development _ <br /> alease cneck orre• ❑ City ❑CounN Permit# G�}4� <br /> File ID#(NdiHerentlromPermltA9 <br /> A. Site Infc�rmation B. Owner Intormation <br /> Address � ii1 '��n ° Sf Owner (owr�eratmneoroonstructlonieceivesu6�lY::exn�N1 <br /> [� �era Ff WH 4`4201 _ Ir. hn l2ob.nBlf' <br /> �i� Zip CompanY 1Ylallbid /�rlrNfs <br /> ' Assessor'S P�opBrtY Tax# (orattach legal descnptionl: _ Add�eSs ?�o(�_f C�I L_��/�d � <br /> {��� - y�{A-nas-���— City �vQiPff State W19-Zip 9g2o/ <br /> Phone ( L�l� 1 ZS 4 — 9n��'� <br /> ServicinaElectricUtilitv PUD �Y�a���sk �d FederallD#orSSN <br /> C. It Singie Family,Zero Lot Ltne or D. If Multifamlly(R-1) <br /> Planned Unit Development � Total#of Buildings <br /> Total Conditioned Floor Area I D�� sq.ft. Total#of Units <br /> Second Duplex Unit sq.ft. Total sq ft (optionaq - <br /> A. Primary Space Heat Type B. Back-UP Spece Heat Type 'C. Water Heat Type <br /> (cheek ons) <br /> (eheck al tl�at applyJ (eheek one) <br /> ❑ Electric Baseboard ❑ None Q Electric <br /> � Electric Wall Heater ❑ Wood ❑ Gas <br /> . ❑ Electric Furnace ❑ Electric Baseboard ❑ Othe�(specify below) <br /> ❑ Electric Heat Pump ❑ Othef (specily belowJ <br /> ❑ Other <br /> This bullding meets the WSEC Compliance Method Date of Permit Application �— ��l-9 y <br /> (� Electric � Prescriptive Path Date Buildinq Permit Issued $ -��,q � — <br /> ❑ Other Fuels ❑ Component Periormance <br /> Date of Insulation Inspection /n",� -Qy <br /> requirements of the WSEC. ❑ System Analysis <br /> Date of Finai Inspection / - �/- �� <br /> 1 ereby certlly that thls bullding or addition has been lnspected lor the measures requJred <br /> y the 1991 ashington St te Energy Code(WSEC), that!t is!n substan (a!complfance <br /> `. th he WSE ,and that t EC checkllst/or is bullding!s on ille. � <br /> Signatur uilding 011icial or Aulhorized Represenlative Dale <br /> Re urn white copy to: Kathleen Skaar, Washington State Energy O(fice, 809 Legion Way SE, FA-11, Olympia,WA 98504-1211 <br /> Uliliry/Owner•Canary Copy Jurisdicfion-Pink Copy <br /> � WSEO•Whife Capy �,gp <br />