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��4r■ • .:. <br />. i <br />� �l ' <br />>>: , 1 I I �, � �: <br />.- • � <br />..,� e- ! � � <br />�(p!e�a cheek oneJ <br />lt�'New Buildin ❑ Addkion over 500 sq. it. <br />Jurisdiction: <br />pees, �;,a� �r: Ckv ❑ CounN <br />(please check one) <br />❑ Single Family ❑ Duplex <br />�ukifamily ❑Zero Lot Line Home <br />❑ Planned Unit Develo ment <br />Permk # ��.� <br />Fle ID # (irdrneremnom Permrtx� <br />A. Sfte intormation <br />Address " <br />CiIY Zi <br />Assessor'sPro eR Tax# orartaonie a�desut aon : <br />! <br />Servicina Electric Utilitv <br />C. It Single Famfly, Zero Lot line or D. Dupl <br />Pianned UnN DevelopmerM First <br />Unit <br />B. Owner Intortnation <br />Owner owrerarmneor ' nrecehes e� <br />� � <br />Com an 5 <br />Address <br />CI� e w n� StatellJA— �� <br />Phone ( � <br />E. H Multifai <br />g, Total N of <br />p, p�kry Spece Heat Type <br />Electric Baseboerd <br />❑ Electric Wall Heater <br />❑ Electric Fumace <br />❑ Electric Heat Pump <br />❑ Other <br />s. seconaar�sPace ►+eat rrpe <br />(chsckd taPP�y) <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other(spacirybelow) <br />C. �eck M) � �r�� <br />Electric <br />❑ Gas <br />❑ Other(saedNeeioWl <br />`"a.pp'' . .�ia�'" i ' 7�M0�t t � . 3 - . ;� F� , <br />��i � z. �i����.����� ��u�l`�� � e b a�wr�.�it�wni�wine• RI� <br />n�� �„ Pu� �ry1 lication <br />WSEC Compliance Method This building meets ihe Date of PertnR ApP % 2�_ <br />Date Buildinq Permft Issued �' <br />❑ Prescriptive Palh ❑ electric Date of Insulation Inspection �P ��� �� <br />❑ Component Pertormance ❑ other tuels Date of Fnal Inspection �/- ��9 S — <br />❑ System Analysis requfrements of the WSEC. <br />1 hereby certify that thls bullding or addRfon has been inspected for the measures requlred <br />by the 1991 Washington Sfate Energy C�de (WSEC), thaf it Is !n subsfantlal compliance <br />,4kh-the WSffC, and trypt the WSEC checklist for thls building Is on lile� �^ _ <br />ONicial or Authorized Representa6ve <br />oate <br />Return canary copy to the servicing elecVicctil�ty to�;g 9e PWO. �ox 43165nOlymp aeWA 98504•3165 <br />Rewm white co to: Katnieen �Kaar, vva������y���� �.�.� -••- " <br />WSEO - Whlte Copy Utility/Owner - Canary Copy <br />Jurisdicfion - Pink Copy <br />