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i� / <br /> ^ r;L r� '%.+ <br /> � � ) <br /> �� Building Record ��� � B <br /> �� <br /> �rcb a��, rw��n�x o�a, <br /> New Bulldiny Addltion over 500 sq.tt. ingle Family ❑Duplex <br /> Jurisdiction: ❑Multifamily ❑Zero I.ot Line Home <br /> ❑Planned Unit Development <br /> peasedreckorre• iri ❑Counri Pertnitk /��Z�9 <br /> � File ID#(ildiNerent�rom PermM+e) <br /> A. Sits Informetlon B. Ownx Inform�tlon <br /> Address 7 0 //An /1P/ Owner to»*�erethmeorcoravucfia�receivesim7iNcarmeM) <br /> �� ��o i Zjp Com en <br /> ASSeSsor'8 Pf0 B Tex N orattachl aldesc' tion : Add�eSS <br /> �J Ci tat Zi � <br /> Servianp Elactric Utility / Phone ( ) <br /> C. M SInpN F�mily,Z�ro Lot Une or D. Dupl�z E. It Multlhmlly(R•t) <br /> Pl�nned Unit DsvNopment First Duplex Unit sq.ft. Total A of B�ildings <br /> Total Conditioned Floor Area .tt. Second Du lex Unit .ft. Total k oi Units <br /> A. Prlm�ry Sp�ce Hs�t Typs B. S�econd�lrnSp�os Neat TY fb C. Weter Heet Typs <br /> ��y�pN� (M�ek NI Mi �ppfyl (N.�ck ons) <br /> ❑ Electric Baseboard ❑ None ���n� <br /> [�Electric Wall Heater ❑ Woal n Gas <br /> ❑ Electric Fumace ❑ Electric Baseboard ❑ Other�speciiy beiaw) <br /> ❑ Electric Heat Pump ❑ Other�specfi�neww) _ <br /> ❑ Other <br /> � <br /> (br�WI Pump QMy) <br /> WSEC Compllence Method This bullr�Ing mests the Date of Permit Application �/-Q� <br /> �Prescriptive Path ❑ electric Date Building Pertnit Issued - <br /> Date of Insulation Inspection ' <br /> ❑ Component Pertormance ❑ other fuels Date of Final Inspection �3 -Q �_ <br /> ❑ System Anaiysis roqulroments of the WSEC. <br /> I hsreby ceRlly th�t this bulldfny or addltlon has besn Inspected lor the measures requlred <br /> by the 1991 Weahlnyton State Energy Code(WSEC), that!t la In substantlel compllance <br /> w h ths WSE , nd t t e WSEC checkllat/or th(a bullding ls on/fle. <br /> /n - — <br /> Signe o(Building Offic al or uthor(zed Representative Date <br /> Return canery copy to ihe servicing electric utility to trigger WSEC compiiance payment <br /> Retum white copy to:Kathleen Skaar,Washington State Energy Oflice, P.O.Box 43165,Olympia,WA 985043165 <br /> WSEO-Whfte Copy Ufility/Owner-Canary Copy � ✓unsdiction•Pink Copy <br /> 12A2 <br />