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suilding Record ��«"'�'` B <br /> �� <br /> � �;;,: <br /> �;� ;,� ` � � IXASS�ICATION -;� <br /> (please check oneJ (please check oneJ <br /> �New Buflding ❑Addition over 500 sq.ft. ❑Single Family ❑Duplex <br /> Jurisdiction: ❑Multifamily ❑Zero Lot Line Home <br /> ❑Pianned Unit Development <br /> please check one• � Clty ❑County _ Permit# � <br /> File ID N if diflerent lrom Permit#� _ <br /> �" �°,jat';� � x ';t '��y�.'.'�.�, °7`r �n�� ° `�'' �vtR.^`r'� <br /> 4 <br /> r V�• <br /> � x S e'�,.'�"� h"` ��".. _ <br /> A. Site Intormation B. Uwner Information <br /> Address Owner f��arnrrraormrsm/caonrece+wsueMroarmentl <br /> City ZiP CompanY -- <br /> Assessor'S Prop�Tax#(ar attach legal descnptian): Address State Zip <br /> Cit�. <br /> Servicin Electric Utility Phone ( ) <br /> Federal ID#or SSN <br /> C. If Single Family,2ero Lot Line or D. If Multifamily(R-1) _ <br /> Planned Unit Development Total#of Buildings <br /> Total Conditioned Floor Area sq,ft._ Total#of Units <br /> Second Duplex Unit sq.ft. Total sq,ft.(optional) _ <br /> t' �" ���:. <br /> _ . _ .. . . . . �T��iC � - - <br /> p. Primary Space Heal T e B. Back-Up Space Heat Typ� C. Weter Heat Type <br /> YP (apNonal,eheek all fhat apply) (opflonel, eAeck one) <br /> (cAeck oneJ ---.—_._ ---- <br /> [� Electric Baseboard ❑ None � Electric <br /> ❑ Electric Furnace ❑ Wood ❑ Gas <br /> ❑ Electric Heat Pump ❑ Electric Baseboard ❑ Oth@f(specily below) <br /> ❑ Other �speary beiow) ❑ Olher�spec�ty beiow) — <br /> -- �ANCE �M�'rTIONl�NFO�EME�'' - <br /> WSEC Compliance Method Date ot Permit Application _ <br /> ❑ Prescriptive Path Date Building Permit Issued <br /> ❑ Componenl Pertormance Date ot Insulation Inspection <br /> ❑ System Analysis Date of Final Inspection _ <br /> 1 hereby certlly that thls bullding or addltlon has been Inspecfed/or the measures required <br /> by the 1991 Washington State Energy Code(WSEC), that!t is!n substantial compfiance <br /> with the WSEC,and that the WSEC checklist for this building Is on lile. <br /> � — __. _—_--._ Date . _ <br /> Signature ol Building Otlicial or Authorized Representative <br /> pelurn while copy to_ Kathleen Skaar, Washingbn State Energy Oflice. 809 Legion Way SE,FA-11, Olympia,WA 98504-12i 1 <br /> WSEO�Whife Copy U�ility/Owner-Cannry Copy Jurisdiction-Pink Copy 6-91 <br />