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Building Record <br />(pl ase check one) <br />flew Build' g [:]Add- ion over 500 q, ft. <br />Jurisdiction:__ <br />please check one: City li Count <br />A. Site Information <br />Address <br />Clt — Zi <br />Assessor's Pro ert Tax # orattach leoat description)' <br />Servicing Electric Utility O pig /j <br />C. If Single Family, Zero Lot Line or D. Dup <br />Planned Unit Development First <br />A. Primary Space Heat Type <br />(check one) <br />❑ Electric Baseboard <br />Electric Wall Heater <br />Electric Furnace <br />❑ Electric Heat Pump <br />❑ Other <br />WSEC Compliance Method <br />❑ Priscriptive Path <br />Component Performance <br />System Analysis <br />• Atta vnm t B <br />,mot# <br />Mease check one) <br />ingle Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />El Planned Unit Development <br />Permit # 2=9 15 <br />File ID # (if different from PermitA <br />B. Owner Information <br />Owner (owxwat Omeofcp bUcVonreCa1.MS Ofi'tv vajnar#j <br />— A V -e— / <br />Com an <br />Address / U z)x <br />City 110r,4 State ,tZip �ji{7 -9 <br />Phone (30& ) 4,t7 9Z:t— <br />I E. If Multifa <br />Unit sq. ft. I Total # of <br />B. Secondary Space Heat Type <br />(check all that apply) <br />None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other(specillbelow) <br />C. Water Heat Type <br />(Check one) <br />X Electric <br />❑ Gas <br />❑ Other(specifybelow) <br />ggwr- <br />(for Heal Purrp Only) <br />This building meets the <br />electric <br />❑ othertuels <br />requirements of the WSEC. <br />Date of Permit Application ,�a7 <br />Date Building Permit Issued 23- <br />Date of Insulation Inspection8 2_ <br />Date of Final Inspection <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 />/�,fth the WS C, and t the WSEC checklist for this building is on file. <br />4 <br />ngw6e of Building Official or Authorized Representative Date <br />Return canary copy to the servicing electric utility to trigger WSEC compliance payment <br />Return while copy to: Kathleen Skaar, Washington State Energy Office P.O. Box 43165 Olympia WA 98504 3165 F 12 e2 <br />WSEC) Mile Copy Utility/Owner - Canary Copy Jurisdiction - Pink Copy <br />