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. . <br />; r-;� <br />. � .� <br />r' <br />Building Record <br />(p/ e check oneJ <br />New Buiiding �] Addition over 500 sq. ft. <br />Jurisdiction: _�� <br />Qease check one CItV ❑ COUnfV <br />A. Site Information <br />Address �Z�� �y� �� <br />C.IfV / ZID � �%�J � <br />AssessOr'S PropertY Tax # or arrach le�l descri tioN : <br />-��� ����-.� <br />Servicinp Electric Utilitv �� <br />C. If Single Famfly, Zero Lot Llne or <br />Planned Unit Development <br />Total Conditioned Fioor Area /Z 3(o sq. N <br />Second Duplex Unit � (o sq. �� <br />A. Primary Space Heat Type <br />(eheek one) <br />�J �leciric Baseboard <br />C��Ele�tric Wall Heater <br />❑ Electric F�rnace <br />❑ Electric Heat Pump <br />❑ Other <br />� <br />Attadment B <br />WSEU Corfiar.�t # <br />(please check oneJ �,/ <br />❑ Single Family Lrl Duplex <br />❑ Multi(amily ❑ Zero Lot Line Home <br />0 Planned Unit Development <br />Permii # �Q� <br />File ID # (ilditlererVromParmitAl <br />B. C •rner Informatfon <br />Owner (rnvneraltimeolcouhuttionrecervesu(lMpaVment) <br />,����r� t <br />Com an <br />Address -� ,rcrr �__� <br />Citv �L State / Qip q p��z <br />Phone ( Zp(n ) 77T-2�Q'� <br />Federal ID# or SSN <br />D. If Multifamlly (R-1) <br />Total # of Buildings <br />Total N ot Units — <br />Tota1 sq, (��onal) <br />B. Back-Up SpaceHeatType <br />�(c iwk all fhat applyJ <br />LiT None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ O�hBf (specil�•belowJ <br />C. Water Heat Type <br />(yheck one) <br />�Electric <br />❑ Gas <br />❑ Oth2� (specilybe/owJ <br />.. , �. � _-,._ _ <br />` ' �� �� "�.�^ ",.��CO�Ihl1ANCE r �- "�.� <br />_ . � . �":�3'} �; t ;� � ��.:1NS��CTIOt�%EN��R��I�II�Cit�'° �^ <br />�.,.��;�� <br />Thls buJlding meets the WSEC Compl(ance Method Date ot Permit Application <br />��Electric ❑ rescriptive Path Date Building Permit Issued �---�� <br />❑ Other Fuels �omponent Performance Date of Insulation Inspection .y 2(_� <br />requirements of the WSEC. ❑ Syslem Analysis Date of Final Inspection /� S - <br />�I hereby cert!/y th thls bu!/ding or add/tion has Geen inspecfed lor the measures required <br />�c the 1991 W ' gfon S te Energy Code (WSEC), tha � is !n substantlal compllance <br />i w! the WSE , a d t hecklist lor this b�i ng�s� /ile. <br />- � �S <br />ol Build g Oflicial or Auihorized Representativo Date <br />_ Return white copy to: Kathleen Skaar, Washinglon State Energy Olfice, 809 Legion Way SE, PA-71, Olympia, WA 98504•1271 <br />WSEO - Whi(e Copy Ulilify/Oirner- Canary Copy -- — <br />Jurisdicfion � Pink Copy <br />792 <br />