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T�13 <br /> . _ _ __ ._ . .. � � I <br /> l <br /> � {^� <br /> �� Building Record ��'�# A� g <br /> z r� �R�1fV1 . --„ � _ <br /> �. <br /> �'a y � � � IXAESIfICAT�N � ��;' <br /> ,ozx <br /> r�� � (p/ease check one) (pfease check ane) <br /> � x� ❑New Building �Addilion over 500 sq.tt. �'Single Family ❑Duplex <br /> �,, � f f- ❑Multitamily ❑Zero Lot Line Home <br /> y� � Jurisdictian• /,� - i '� c <br /> ❑Planned Unil Development_______ <br /> O SO „ <br /> � yH � --- - -- , <br /> y t. please cbeck one: �C�tY ❑COunty Pefmit#_���-'� <br /> x y� FIIO �.7�(ilOiNerentlrom Per+mf XI <br /> �:� I! __. . __.....,.-�.�.-a ,7.��'�r <br /> � ...x. , .�.� e.,.. { <br /> � .__. . � - � �;._ <br /> , _.. _: .- _�_. �,-� : _. : , , ... --, <br /> OH ._. _. .. _ _ - . . -, . <br /> � �g , __ <br /> ��� B. Owner Informetion <br /> H � �i A. Slte InlormaUon . --- -- <br /> a H I Address _ �,;,�;_((11a,.��Lt�- Owner �o�merarraneorconswa�rece�vesunrayaaymerni <br /> � <br /> r x -�u..�/�—J-/ /),< , ., ,� . lt��,,�. >o I <br /> t-�H � --_ — ' <br /> g �'r+ � CiN ��d Yii j�' ZiP� ' �� ���(i�' Com an <br /> � GU' � Assessor'sProp�TaxM/orattach�ega�desa� rion): Address /��� �i.�-� ' ��'�'- I <br /> ��i C�.t. Cy [L ll � Statet � �` ZiP 71�L8 � <br /> �'trjf � �ri�y' 1"�/-�1' 'L. ,_��4Z1.,�.�� Phone ( �, � ] "�.� / - ° 7_30 <br /> y o� !, Servicing Eledric UUI�_�/j��,p ,r��/�--- - Federal ID#or SSN ___ I <br /> I <br /> � C. If Single Family,Zero Lot Line or D. If MultHemlly(R-1) I <br /> ' Planned Unit Development _ Tolal#ot Buildings _ i <br /> i Total Conditioned Floor Area �f�q•fi Total#of Unils_ _ <br /> Seco_nd Du lex Und _ sg. ft. ToI�I sq.(L {optional� __ <br /> '"' -- —� _ , . <br /> -- � i � • �� � �' I�AT SOURCE ---- - �'�� <br /> �t- .� S tace Heat Type B. Back-Up Space Heat Type C. Water Heat Type <br /> � I� A. Primary P �cneck eil tAaf aPP�Y) lcneck one/ <br /> �, � , (check one) __ _ <br /> ❑ None ❑ Electric <br /> i ❑ Electric Baseboard ❑ Gas <br /> ry]'Electric Wall Heater ❑ Wood <br /> �! � � ❑ Electric Fumace ❑ Electric Baseboard ❑ Olher/spedrybeiowl <br /> s ( I ❑ Electric Heat Pump ❑ Other�specirybeiowl -- --- -- <br /> ��4 1 ❑ oin�� ------- ------- —-- <br /> �I COMPUANCE INSPECI'10111�� '�� <br /> I __ <br /> , <br /> �_, � � This building meets the WSEC Compliance Method Date of Permit Application __-I� >;; i/�__ _ _ I <br /> Date Bwldin Permd Issued_ `� <br /> � ❑ Electric � Prescriptive Path 9-- --���1��L--— <br /> ', P Date ot Insulation Ins ection 1„1 ��_`t.�— <br /> ❑ Other Fuels ❑ Com onent PeAormance Date of Final Inspecl on 1 � / i'`�� I <br /> � 1 I requi:ements of the WSEC. ❑ System Analysis <br /> i <br /> I 1 hereby certlty that th(s bWlding or addlflon has been Inspected lor fhe measures requlred I <br /> . ' by the 1991 Weshington State Energy Code(WSEC), that!t is(n substanNal compllan�e �I <br /> with fhe WSEC, and�at the WSEC checkllst lor this bulWfng is on tlle. <br /> , <br /> -.� > '"' - -- — - <br /> i ., % `�-``- _ _ -- ----�-=-`- _ .'_ _ _ _ __ <br /> I Si�nature of Duiltling O��icial or Authorized Representa�ive Date <br /> Return while copy ta: Kathleen Shaar, Washington Stato Energy 011ice. 809 Legion Way SE.FA-11, Olympia,WA 98504-1217__ II <br /> �i WSEO-While Copy� � Ufilify�'Owner�Canary Copy Jurisdicfron�Pink Copy � <br /> 7 92 I <br /> i <br />