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��/` iNGTON Atmciment B <br /> Buildi�g Record ��» <br /> �� <br /> ; <br /> jF�•le�as check anu) � (please chack one) <br /> E�"New Efullding Addltlon over 500 aq.tt. �ingle Family ❑Duplex <br /> Jurisdicti��>��.l�P� �.7.�� ❑Multifamily ❑Zero Lot Line Home <br /> � �/ ❑Planned Unit Oevelo ment <br /> vlease cns�k one: �Etv ❑County Permit# v�i r — <br /> FIIB ID#(ildiNerenflrom Permit A1 <br /> A. Site Informetion B. Owner Iniormatlon <br /> Address ��D/ /,Il� � Owner low,ieratrlmeorcons5vdlonraoeivesufilnrvermen0 <br /> City Zip � Com an � /LO/ <br /> Assessor'sPro e Tax# orattacnl aldescri rion : Address �•�y�p� �_y-� " � <br /> `� — CItY �1LsLiLc�at � ZI Z � <br /> Servicinq Electric Utility ; r: � Phone ��f,ff� �37-}/�c�'r <br /> C. If Single Famlly,Zero Lot Line or D. Duplez E. It Multifamily(R-1) <br /> Plenned Unit Development First Duplex Unit sq.ft. Total#ot Buildings <br /> Total Conditioned Floor Area � s .ft. Second Du lex Unit s . ft. Total#of Units <br /> A. Primery Spece Heat Type B. Secok de�rk�aPP��Heet TYPe C' Whsck on�t Type <br /> (eheck on�) ( <br /> ❑ Electric Baseboard ❑ None Electric <br /> �Electric Wall Heater ❑ Wood ❑ Gas <br /> ❑ Electric Furnace ❑ Electric Baseboard ❑ Other(specrry beiow� <br /> ❑ Electric Heat Pump ❑ Other(speatyeeiow� . <br /> ❑ Other <br /> (la Meat Pump Only) <br /> WS,E�C,/Compllence Method Thls building meets the Date of Permit Application �/-9[� <br /> L�J Prescriptive Path ❑ electric Date Buildinq Permit Issued //� <br /> ❑ Component Performance ❑ other tuels Date of insulation Inspection 2 -/3 �9s <br /> ❑ System Analysis requirements of the WSEC. <br /> DateofFinallnspection .J-lLa�9S ___ __ <br /> I hereby certfly that thls bullding or additlon has been lnspected!or the measures requlred <br /> by the 1991 Washfngfon State ergy Code(WSEC), that It!s In substantial compllance <br /> wlth he WSE and at th EC h lor thls bulld! g�on Ile. <br /> Signature of Building OHicial r Authorized resentative Date <br /> Return cenary copy to ihe servicing electric utility to trigger WSEC compliance payment <br /> Return white copy to:Kathleen Skaar,Washington State Energy Office, P.O. Box 43165,Olympia,WA 98504•3165 <br /> WSEO-Whifo Capy . Ufility/Owner-Canary Copy Junsdiction-Pink Copy <br /> 12•92 <br />