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1 . � <br />�- �� <br />�,_, �_ <br />> >- <br />... , <br />:u• - � <br />= <br />Building Record <br />l� . :.i... I.�. <br />(please check one) <br />� New Buflding ❑ Additfon over 500 sq. tt. <br />Jurisdiction: <br />please chedc one� � Clty ❑ COUnty <br />W 'r'. t ti. ; <br />��' :.i„�t.. <br />A. Site Information <br />Address <br />n- <br />.. yv..:. �� .. <br />CitY Zip <br />ASSBSsof'S PfOpBRy TaX #(or attach lagal descnption) : <br />Servicinq Electric Utiliry <br />C. If Single Family, 2ero Lot Line or <br />Planned Unit Development <br />Total Conditioned Floor Area ' Sq. h. <br />Second Duplex Unit sq. tt. <br />A. Primery Spece Heat Type <br />(chxk one) <br />❑ Electric Baseboard <br />❑ Electric Furnace <br />❑ Electric Heat Pump <br />❑ OthBf (spedfy bebw) <br />r�;., ■ . .,". <br />WSEC Compliance Method <br />❑ Prescriptive Path <br />❑ Component PeAormance <br />❑ System Analysis <br />��� <br />(please check one) <br />❑ Single Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit # <br />File ID #(it diNerent �rom Permit +Y� <br />Attedrroit B <br />A ', <br />. . ;�=1, > .. <br />B. Owner Information <br />Owner (wmer ar nme or oorem�edon rece+ws uoarr aar�0 <br />Company <br />Address <br />Ciry State Zip <br />Phone ( 1 <br />Federal ID# or SSN _ <br />D. If Multifamily (R-1) <br />Total # of Buildings <br />Total # of Units <br />Total sq. ft. (optional) <br />. IEAT f011RCE <br />B. Beck•Up Space Heat Trpe <br />(opNond, ehsck ell thaf epp y) <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Oth@� (speciry belowJ <br />,.. - ..,� ,�.r �. -_r,+;, <br />C. Water Heat Type <br />(aptlond, chsek oro) <br />❑ Electric <br />❑ Gas <br />❑ Other �specrry bebw� <br />IN3PECTIOMIE�I��: '`; <br />Date of Permit Application <br />Date Buildi�no, Permit Issued <br />Date of Insulation Inspection <br />Date of Final InsQection <br />1 hereby certl/y that thls building or addltlon has been lnspected /or the meesures reqw <br />by the 1991 Washington State Energy Code ( WSEC), thaf !t !s !n substanNal compllence <br />wlth the WSEC, and that the WSEC checklfst lor this bullding is on flle. <br />Signature ot Building ONidal or AWhorized Representalive <br />Date <br />Return whlte copy to: Kathleen Skaar, Washington State Energy Ottice, 809 Legion Way SE, FA-11, Olympia, WA 98504-1211 <br />LYSEO - White Copy Utility/Owner • Canary Copy Jurisdidion • Pink Copy g-g� <br />