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oft J1 <br />�A,■ a <br />•'�i ii <br />Building Record <br />(pease check one) <br />❑ New Building Addition over 500 sq. It. <br />Jurisdiction_ <br />pease area, one Q City ❑ County <br />A- Me Information <br />Address ) j) i 'jc4 ' ) ) E <br />City % Ziple— <br />Assessor's Property Tax # for attach legal description) <br />1-,J,4+a ( *-IIr ! `' I/r (` at'1 nallJ <br />SeMclro Electric tjtility R d F I, n w� <br />�, 5.,v.Cer- PUii)I'I <br />C. If Sinfb Family, Zero Lot Line or <br />_ Planned Unit Development <br />Total Conditioned Floor Area s9• n•_ <br />Second Duplex Unit _ _sq. ft. <br />A. Primary Space Heat Type <br />(check one) _ <br />❑ Electric Baseboard <br />❑ ElectricFwn-ce <br />❑ Electric Heat Pump <br />❑ Other (specify below) <br />e.. <br />WSEC Compliance Method <br />❑ Prescriptive Pz h <br />❑ Component Performance <br />❑ System Analysis <br />04 <br />Atbdrflent B <br />VM Canhad # <br />(please check one) <br />©Single Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit# <br />File ID # (11 different Irom Permit M <br />B. Owner Information <br />Owner (owner at Urneof oyskuction receives u.W '+MrenU <br />Address !-1 II r v --- <br />City r- , r _ State I I) Zip <br />Phone <br />Federal ID# or SSN <br />D. If Multifamily (R-1) <br />Total # of Buildings _ <br />Total # of Units <br />Total sq. fL Copttc nal) - <br />B. Back -Up Space Heat Type <br />(optional, check at/ that apply) <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other (specify below) <br />C. Water Heat Type <br />(optional, check one) <br />❑ Electric <br />❑ Gas <br />❑ Other (specify below) <br />Date of Permit Application _ <br />Date Building Permit Issued <br />Date of Insulation Inspection <br />Date of Final Inspection <br />I hereby certify that this building or addition has been Inspected for the measures I equi <br />by the 1991 Washington State Energy Code (WSEC), that it is in substantial compliance <br />with the WSEC, and that the WSEC checklist for this building is on file. <br />Signature of Building Official or Authorized Representative Date <br />Return white copy to: Kathleen Skaar, Washington State Energy Office, 809 Legion Way SE, FA-11, Olympia, WA 98504.1211 <br />WSEO - White Copy utility/Owner - Canary Copy Judsdiaon -Pink Copy 8-91 <br />