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��Vl71VIV r � � C'�l� c � <br /> � �, �,- � } <br /> � Building Reco�d ��� "�` B <br /> �� <br /> ase checlr ona) (please check one) <br /> New Bulldfi � ❑Addiion over 500 3p,ft. �Single Family ❑Duplex <br /> Jurisdiction: Ci( p�t� F,,/..E1Ei��' ❑Multifamily ❑Zero Lot Line Home <br /> ❑Planned Unit Develo ment <br /> p�ease cneck one: � i,itv ❑Countv Permit# �n2 <br /> File I D#(il diHerent from Permit M <br /> A. Site Informetlon B. Owner In(ormatlon <br /> Address ,�3LP / ✓.� C� Owner lownerarmnewronswcna,�eceivesunrrtvaavmernl <br /> CiN �/.et.? Zio � � Com an •.erS c�G o <br /> Assessor's Pro Tax# orarrecn aide ' rion : Address �' '� <br /> �� iaoa-a5-g3 c� StateG�/A z� aa <br /> ServicinflElectricUtiliN �%no (o r,! Phone ( �O(o )��- � s <br /> C. If Single Famlly,Zero Lot Line or D. Duplex E. If Multifamlly(R-1) <br /> Plenned Unit Dsvelopment First Duplex Unit sq,ft. Total#of Buildings <br /> Total Conditioned Floor Area.[�c:�q,ft. Second Duplex Unit sq.ft i Total#of Units <br /> A. Primary Space Heat Type B. Secondary�Heat 7ype C. Wh�kr H.�t Type <br /> (ChIC�(OMI (ChN;A(d/fMf � <br /> ❑ Electric Baseboard � None � Electric <br /> � Electric Wall Heater ❑ Wood ❑ Gas <br /> Electric Furnace ❑ Electric Baseboard ❑ Other�speciyberow�. <br /> ❑ Electric Heat Pump ❑ Other(specityberow/ <br /> ❑ Other <br /> (ror Hwt Paro onNl <br /> WSEC Compllance Method This building meets the Date of Permit Application 3 -��9S <br /> ❑ Prescriptive Path � electric Date Buildinq Permit Issued -2l_ �"�' <br /> ❑ Component Performance ❑ other fuels Date of Insulation Inspection Ln -ZZ-�— <br /> ❑ System Analysis requlrements of the WSEC. Date of Final Insuection �-�L-q� <br /> I hereby cert!!y that thls bullding or addlNon has been lnspecfed lor fhe measures requlred <br /> by the f991 Washington St te Energy Code(WSEC),that It ls In substentlal compllance <br /> � wlt the C,an th WSE eckllst Ior thls bui Inp`�/,pn 1 e. <br /> � �G <br /> Signature of Building OH cial o Authorized RepresentatNe Dale <br /> Return canary copy to the servicing electric utility to irigger WSEC compliance payment <br /> Return whlte copy to:Kathleen Skaar,Washington State Energy OHice,P.O. Box 43165 Olympia WA 985043165 <br /> WSEO-White Copy Utiliry/Owner•Canary Copy Junsdicfion-Pink Copy <br /> 12•92 <br />