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WASHINGTON <br />ENERGY <br />�� <br />(please check one) <br />�New Building <br />Jurisdictian: <br />Buelding Record <br />❑ Addition over 500 sq. ft. <br />p�ease check one• � CiN ❑ County <br />A. Site Informatfon <br />Address .SOOW ��3�v W �6/'iA� ��ihw! Ut <br />Cit - J� !� ��'I�' Zip Q FLO i <br />AsSessOf'S Property T8X #(orattach leaal descnption) _ <br />���5 77_Z (�Z7 60 07 <br />Servicinq Electric Utili �� L)� I��p/� r. F ,D},en,��l, Co <br />C. If Single Family, 2ero Lot l.ine or <br />Planned Unit Development <br />Total Conditioned Fioor Area �C7� SQ• K• <br />Second Duplex Unit sq. k. <br />A. Primary Space Heat Type <br />(check one) _ <br />Eleciric Baseboard <br />❑ Electric Wali Heater <br />❑ Electric Furnace <br />❑ Electric Heat Pump <br />❑ Other _ <br />Attachr��ent B <br />(please check one) <br />❑ Single Family ❑ Duplex <br />� Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit # a % it �%G <br />File ID #(il diHerentlrom Permi� t!I <br />B. Owner Inf �rmation <br />OWn@f (ownerifNmeolconswctionreceivesuATirypaYmenU <br />'A%n n a KI �,� , i n s Ce.0 l� <br />Company <br />Address 34U1-2GZ�d S'�_J'�,) <br />Citv I.,N��addd_ State �lf} Zip 9XU3G <br />Phone ( ZG�O ) � � L'(�i8 <br />Federal ID# or SSN <br />D. If Multifamily <br />Total # of Buildings � <br />Total # of Units '�i <br />Totalsq ft (optional) 7i 35G <br />B. Back-U� Space Heat Type <br />(check al fhat appry) <br />None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ OthOf (specilybelow) <br />C. Water Heat Type <br />(check oneJ <br />Eiectric <br />❑ Gas <br />❑ OthO� (specilybelowJ <br />�A � � <br />� ��CiiR1�iT�iC�"'�`� _ �i � �-�"�A�����'Ii1�!/EN�IC,EFIf� - <br />. -. . ; HL+' . a* + <br />This building meets the WSEC Compliance Method Date o! Permit Application �'- („ -�1 � <br />� Electric Prescriptive Path Date Buildinq Permit Issued 11- t S-9 I _ <br />❑ Other Fuels ❑ Compunent Periormance Date of Insulation Inspeclion �- �7- 9Z <br />requirements of the WSEC. ❑ System Analysis <br />Date of Final Inspection 7-7 -�l 2. <br />1 hereby certlfy that thls building or addition has been Inspected /or the measures requlred <br />by the 1991 lNashington State Energy Code (WSEC), that !t !s In substantial compliance <br />�vftp the WrSEC, and tfjat the WSEC checkllst tor this build�ng%s�o�il�� � <br />of Building Olficial or Authorized Representative <br />Dale <br />etum whde copy to: Kathleen Skaar, W2shington State Energy O(lice, 809 Legion Way SE, FA-17, Olympia, WA 98504-1211 <br />— ,—�— Utility/Owncr - Canary Copy Jurisdiclion - Pink Copy <br />WSEO - Ithife Ccpy <br />7�?2 <br />