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�/�TDf�� <br />PROGf�Vvl <br />(_' <br />��il�ing Record <br />(pl se check oneJ <br />New Building Addition over 500 sr,, tt. <br />Jurisdiction: �y// l �J� ��� ,�_ <br />� <br />pleasecheckone� ity ❑COUfIiV <br />A. Site Information <br />Address �S� _,�__ <br />cc 2 z 20 �_ <br />ASSeSSors PfOp@_Ry Tax # o'attarhlegaldescrrPfion : <br />_.L(7%� (O aT <br />Servicinq Electric Utilit�fY,� �� <br />C. If Sfngle Family, Zero Lot Line or <br />Pianned Unit Development <br />Totai Conditioned Floor Area � Z3 _s�. ft._ <br />Second Duplex Unit 1'L3� sq. ft. <br />A. Primary Space Heat Type <br />(check one) <br />L7�Electric Baseboard <br />ra Electric Wall Heater <br />❑ Electric Furnace <br />❑ Electric Heat Pump <br />❑ Other <br />�1 <br />Attachne�tt B <br />WSEo Cantracc # <br />(pleasa check oneJ <br />❑ Single Family Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit #�1 /j�� <br />Fi18 ID #{ildillerent Irom Permit A) <br />B. Owner Information <br />�WnBf lowneratfimeofconsp�ctionieceryesufil' neM _ <br />✓ _LZI L_lJ-Q� <br />Companv . <br />Address �/f� p�L�,n� /, <br />Cil--��—. _2uV�� $�diB B��ZID YiPZ92j <br />Phone ( 9�/�, ) 7.i-9�.�_'1— <br />Federal ID# or SSN <br />D. If Multifamity (R-1) <br />Total # of Bui�dings <br />Totai # of Units <br />Total s�N Lptional� <br />B. Back-U� Space Heat Type <br />heckel fha(apply) <br />None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ ��IIBf(specifybelowJ <br />C. Water Heat Type <br />heck ane) <br />Electric <br />❑ Gas <br />❑ �ih2f (spr.cilybelowJ <br />-,�. _.. ;. ��,-�,n�-_ <br />: �..�111�IPLjANCE ":° :.�.�; : � : �T', , . , � -1N�1���'10�1[EI��OR�E�� �� <br />This byfld(ng meets the WSEC Compi(ance Method Date of Permit Application <br />�Electric ��� <br />❑�rescriptive Path Date Buildinq Permil Issued 2 ZZ- <br />❑ Other Fuels Q' Compor,ent PeAormance Date of Insulatior, Inspection __� -��- <br />requlrements of the WSEC. ❑ Syslem Analysis Date of Final Inspection (p -I (�-C)S <br />I here6y cerfl/y tho( ;hl� building <br />by the 1991 Washingro State E <br />� it7 the WSE� a� ff� the l�� <br />Signature ol Building <br />Representative <br />addition has been �nspected lor the measures requlred <br />�y Code (WSEC), that !t is in substantial comppan�e <br />chec rlis !or thls buil fs/,G�/�J� le. <br />��C%l!`W---- - `�" �� <br />Dale / <br />Relurn white copy to: Kathlcen Skaar, Washington State Energy Olfics, 809 Legion Way SE, FA-17, Otympia, WA 98504-1 2 7 1 <br />WSEO - Whit2 Copy Ulility/Owner - Canary Co ---- <br />P1' Jurisdic(ion - Pink Copy <br />7-92 <br />