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�F� <br />ro � y <br />q �3 N <br />K � f: <br />H }t <br />V y '�M9 <br />K y � <br />o�Q <br />N l9 R <br />n• <br />M <br />¢y y <br />r H y <br />N <br />FI <br />O N <br />�1°trs <br />O N <br />, �� <br />�11 <br />�� <br />W� <br />�E� <br />Building Record <br />CLASSIFICATION <br />(please check one) <br />❑ New Building ❑ Addflion aver 500 sq. ft. <br />Jurisdiction: ___ _ ___ _ --- -- <br />please check one� ❑ City ❑ COUOty __ <br />A. Site Information _. _ _ _ <br />Address — <br />V 1� � <br />AsSessor's Pro erty Tax #(or arracn �ega� descriPnon/ : <br />ServicingElectricUtility_______ ._—.-- -. <br />C. If Single Family, Zero Lot �ine or <br />Planned Unit Develop��enl <br />Total Conditioned Floor Area _ _ <br />Second Duplex Unit __ <br />A. Prfmary Space Heat Type <br />(check one/ <br />❑ Electric Baseboard <br />❑ El�ctric Furnace <br />❑ Electric Heat Pump <br />❑ ��hBf (speaty below) <br />COMPLIANCE <br />WSEC Camplian �d <br />I �� �� ❑ Prescriptive Path <br />� ❑ Component Pertormance <br />- ❑ System Analysis <br />pttaqm�d B <br />NfSEO Contract # <br />(please check one) <br />❑ Single Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit # _ <br />File ID # {ildiNerenllrom Permif 1t�_ __ _ _- <br />CONSTRUCTION <br />sq.fl. <br />— 59. ft. <br />B. Owner Inlormation _ <br />Owner (rnme'ati�meolronsmxfionreceivesutlityparmentl <br />Company ---- _ — _ — <br />Address _ _ — <br />City ___ State <br />Phone _ {_ _�_ __ __ <br />Federal IDf! or SSN _ _ <br />D. It Multi(amily (R-1) <br />Tctal q ot Duildings <br />Tolal # ot Unils <br />Total sq. fl. (optional) _ _ _ <br />►AEl1T SOURCE _ __ � <br />8. Back-Up Space HeatTYpe <br />(op(lonal, check all fha( apply) <br />❑ None <br />❑ Wood <br />❑ Electiic Baseboard <br />❑ Olher (spai�y below) <br />C. Water Heal Type <br />(optlonal, check oneJ _ _ <br />❑ Electric <br />❑ Gas <br />❑ Other/specr�yberow/ <br />INSPECTIOIUENFORCEMENT <br />Date of Permil Application _ <br />Date Building Permit Issued <br />Date o( Insulation Inspection - ' <br />Date of Final Inspection _ _ _ _ . _ _ _. _ <br />1 hereby certlly that fhls 6ullding or addiflon has 6een inspected lor the measurns required <br />by the 1991 Wash(ngfon Sfate Er.�rgy Code (WSEC), thaf il fs in subsfenUal compllance <br />with the WSEC, attd thnt the WSEC checldisf for this building is on /ile. <br />SignaWre o� Ouiiding OHicial or Authonzed Represenlalive <br />Data <br />ReWm while copy to: Kathleen Skaar. Washington State Energy Office. 809 Legion Way SE, FA-17, Olympia, WA 98504-1211 <br />WSEO - Whi(e Copy Ulioty'Owner � Can.�ry Copy Jurisdiction � P�nk Copy g-g� <br />