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Building Record <br />(please check one) <br />ew Bui RNIdling .n Addition over 500 sq ft. <br />Jurisdiction: �Jl� u � .D/'�ff'" <br />r <br />please check one: Cit ❑Count <br />A. Site Information <br />Address DR./ <br />City Zip <br />SB 2!L Pro a Tax # or attach legal <br />desai ttion : <br />3 6 - <br />Servicing Electric Utility <br />C. If Single Family, Zero Lot Line or D. Dup <br />Planned Unit Development F First <br />A. Primary Space Heat Type <br />(check one) <br />❑ <br />Electric Baseboard <br />Electric Wall Heater <br />Electric Furnace <br />❑ <br />Electric Heat Pump <br />❑ <br />Other <br />WSEC Compliance Method <br />❑ Prescriptive Path <br />Component Performance <br />❑ System Analysis <br />J' <br />• Attat:Nttt W B <br />WSEO Conbact N <br />Mease check one) <br />Single Family [:]Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit # yy,9a y <br />File ID # (if different from Permit k) <br />B. Owner Information <br />Owner ownerar6meof co sstru on�recei-resutr7MpaNnenr) <br />Company <br />Address PO . ok 33Lslo <br />City State(i4 Zip Cf �O3 <br />Phone ) -3 - <br />E. If Multifai <br />Unit sq. ft. I Total # of <br />B. Seconda7 Space Heat Type <br />(check aff t at apply) <br />X None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other (specify below) <br />C. Water Heat Type <br />(check one) <br />Electric <br />Gas <br />❑ Other (specify below) <br />(lo, Hse Pump Only) <br />This building meets the <br />Date of Permit Application - <br />❑ electric <br />Date Building Permit Issued <br />❑ other fuels <br />Date of Insulation Inspection - 7 - <br />requirements of the WSEC. <br />of Final Inspection <br />-Date <br />I hereby certify that this building or addition has been inspected for the measures required <br />by the 1991 Washington State Energy Code (WSEC), that it is in substantial compliance <br />with the W EC, <br />and that the WSEC checklist for this building is on file. <br />i/- <br />bignatule of Building Official or Authorized Representative Date I I <br />Return canary copy to the servicing electric utility to trigger WSEC compliance payment <br />Return white copy to: Kathleen Skaar, Washington State Energy Offire, P.O. Box 43165, Olympia, WA 98504-3165 t2.9a <br />WSEO - While Copy Utility/Owner - Canary Copy Jurisdiction - Pink Copy <br />