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. IN�TON �� �� <br /> � Atladrne�d B <br /> � Building Record ,�o�� <br /> � <br /> '��� `� r ., � .;;,,,, ....� �. <br /> �����\ � � � iu.\ �. ^`�.� ��� `� . h._U� .... <br /> ` . . . � <br /> .. �����Z����....�'��. . . .. ���� � ' .� ' ° � , �� ��.N.�a. . ....��_,.`.�e.. :\\`,'c�4 <br /> � . . <br /> :...__... .. . .... Z�,a � .� � �.. .. <br /> (please ehecic oneJ (p'ease chack one) <br /> ❑New Building�]Additfon ov r,500 sq.tt. �le Family ❑Duplex <br /> Jurisdiction: � � ❑MuRifamily ❑Zero Lot Line Home <br /> ❑Planned Unit Develo meM <br /> pease cr,ecx one: �'Eitv ❑Counri Permit# .,ly/S <br /> FiIB ID#(Hd'dlerent'rom Permh+ll <br /> �:.:�����a i•`;t���.�i���� � �, .���$ �.����� <br /> .�a...;.�.<...o.r�:�.�m��um.ca��.a�.xc.�.va.� a...c�.�.y��aur�cw�a�c��e�.ea�ceca •....�•Tc�e���v.e.�sc�ew�a�u��� <br /> \\\ �e '�E�P�L'RRF H"�.A��`iiA 4AV.F. `�h.,� R� ��,�^�.� <br /> A. SNe Informffiion • B. Owner Iniormation <br /> Address (�� � �j Owner oK,wrar � eo�oonscucnw,reeer,ss � e,rt <br /> Citv Zi � �� — <br /> Com an <br /> Asse or's Pro ert Tax# wsrcach�e a�desar rta, : Address <br /> Ci State <br /> Servicinp Electric Utilitv o 1. � Phone ( 7_/l/., �3/�7 — %// <br /> C. If Single Family,Zero Lot Lir.e or D. Duplez E. If Multitamily(R-1) <br /> Planned Unk Development First Duplex UnR sq.R. Total A�of Buildings <br /> Total Corxiitioned Floor Area .ft. Second Du lex Unit .ft. Total#of Units <br /> �, , � < <br /> � � <br /> A. Primary Space Heat Type B. Secondar�Srace Heat Type C. Water Heat T - - <br /> (drxkoM (checkell tepplY) (dreckone) � <br /> ❑ Electric Baseboard one $Efectric <br /> ❑ Electric Wall Fleater ❑ Wood ❑ Gas <br /> 0 Electric Fumace ❑ Electric Baseboard ❑ Other�sPsdybeaw� <br /> ❑ Electric Heat Pump ❑ Other(sF,eciybenw) <br /> ❑ Other <br /> r �':�. <br /> .. .�wN«�.���M . <br /> WSEC Compliance Method Th(s buildtng meets the Date of Permit Application ,�^_;�� �.�_t��( <br /> �Prescriptive Path ❑ electric Date Buildin Permft Issued � � <br /> C Component Perfortnance ❑ other fuels Date of Insulation Inspection / Z— '-� <br /> �� System Analysis requirements oi the WSEC. Date of Fnal Inspection S —/— 9,$ <br /> /hereby certily that thls bullding or addltlon has been lnspected/or the measuies requfred <br /> y the 199f Washington Stafe Energy Code(WSECJ, thaf it!s In subsfanflal compliance <br /> the EC,a that the WSEC check!!st for this buflding!s on flle. <br /> S S 9 <br /> SlgnaNre uiidirg Offidal or Authorizad Representauve Date <br /> Return canary copy to the servicing electric utllity to trigger WSEC compliance payment <br /> Return white copy to:Kathleen Skaar Washfngton State Energy 011ice P 0 Box 43165 Olympia WA 98504 3165 �z 5z <br /> WSEO-Wh�te Copy Ufility/Ow-ner-Canary Copy Jurisdction-Pink Copy <br />