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�� • <br />�,��i � <br />> > ._ <br />.. . � <br />..� .� <br />i''�. <br />Building Record <br />ase check one) <br />New Bulldl Additlon over 500 it <br />Jurisdiction: � �J F1,�Q� <br />�� �� a�a� CiN ❑ CounN <br />A. Site Information <br />Address /�i /D - � �n .. <br />Ci p Q T �fJ� <br />Assessor's Pro Tax # aanad� i non : <br />_ l_ <br />Servicina Electrfc Utfli p �! <br />C. If Single Family, 2ero Lot Line or <br />Plannsd Unit Development <br />Total Conditioned Fioor Area 5, h. <br />3econd Uuplex Unit s. ft. <br />A. Primary Spacs Flset Tl�pe <br />(cMck om) <br />.❑cf Electric Baseboard <br />�p. Electrfc Wall Heater <br />❑ Electric Fumace <br />❑ Electric Heat Pump <br />❑ Olher <br />:-` <br />Atbdrnent B <br />MIS� Co��traCtN <br />(please check one) <br />❑ Single Family � Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Develo ment <br />Pertnit # QSi,I� <br />FIIB ID #(N dlHerent hom PermN A1 <br />9• Owner Infortnetlon <br />reaerai iuA or 55N <br />D. !f MuMifamlly (R-1) <br />Total # of Build�ngs <br />Total # of Uni;s <br />Total sa. ft. (o tional <br />B. Back-Up Sp8ce HeatType <br />(eMc0.� •1! rn�(yP�Y) <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other(sper.irybeWwJ <br />C. Water Heat Type <br />(cMat or») <br />Eledric <br />❑ Gas <br />❑ Other �specxyeelowj <br />This building meets 2hs WSEC Compliance AAethod Date ot Permit Application -/�p� <br />� Electric � Prescriptive Path Date Buildin4 Permit Issued (��& -S 3 <br />❑ Other Fuels Component Performance Date of Insulation Ins ction <br />roqulrements of the WSEC. ❑ System Analysi, Date of Final Inspection 7`Z.p-9 <br />� heroby cert//y that thls bW/ding or addltlon hrs been lnapected /or the measuros requlrod <br />by fhe 1991 Waah/ngton Stafe Energy Code (WSEC), thet /t !a /n subatanHal compllanre <br />✓� the YrSEC, a� WSEC checkllst /or thls bu!lding !s or, .. ,,. � <br />Buildi;g Oflicial or Authorized Representative <br />whits copy to: N <br />WSEO • White Copy <br />Date <br />n State Energy Oflice, 8( <br />UfilityrtJwner - Canary Copy <br />Olympia, WA 96504-1211 <br />Junsdiction - Pink Copy <br />7�92 <br />