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I <br />� <br />. � <br />Y.Y <br />�,�' � I I �� � 1 1� �. <br />. � .. <br />tpwi}��'i�'r.i'.°.��y�, '✓� t� ».i Y S{, 'Si.'�..t.' .�..�.y'`.." _ �, '� j��y( I ��`.�' o7`'t'. . ...t,.�s �t''+.F� ynr"`t�? �.-' - <br />. i'1 :tti.+.a>'A1:k'.fY6h:..:�.��i-nSS��.'€:-`:�id^a�.'hi. ;.SYEL`�'+l'A�2.... s;.; k:a_ ;:.e...r �"._�S"r_"�.ea.,_ � i� <br />(piease check one) � <br />❑ New Building � Additlon over 500 sq. tt. <br />Jurisdiction: �'' 1 . nQ c.,viPlf <br />p�oase check one: �CitY ❑ CountY <br />(please check onej <br />� Single Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit# �' UJ?SB�i <br />File ID #(tI diHerent lrom Permit A1 <br />� yi ���} �j , ,�. . }-+-� , <br />�. . r �^ y ..i, �ht,. i' : � ? � .^_1'•�/L��:�A-^-�S�ltr r "... w'.•..i r};'i.'T'.,� . . . <br />A. Site Information <br />Address �,�Z�, ����Gr G.la.i <br />CiN �,/P io a1.. ZiP �j kJ D�f <br />AsSessor'S Pfopefty T2X #(ar attach leaal descnplion) : <br />- '� � ��(%L6�RZ_C-C1l�CL� <br />c=,yicinq Electric Utiliry P U.�) +�! r-F ��n,.,�.1. �d, <br />B. Owner Information <br />Owner (ownerarttmeo�consaucrionrecervesun�lraermerrt) <br />-jo n� m i !Ln I �S <br />CompanY <br />Address ��SZ� Xru'o� /,tJe•/ <br />Ci - State Zi l � <br />Phone ` ( ZC>(n ) s� -�a7 q <br />Federal ID# or SSN <br />C. If Single Family, Zero Lot Line or D. If Multifamlty (H-1) <br />Planned Unit Development Total # of Buildings ' <br />Total Conditioned Floor Area ,S� 3 R'" sq. ft. Total # of Units <br />Second Duplex Unit sq. R. Total sq ft(optionap <br />A. Primary Space Heat Type <br />(eheck one) <br />❑ Electric Baseboard <br />❑ Electric Wall Heater <br />❑ Electric Furnace <br />❑ Electric Heat Pump <br />❑ Other <br />B. Back-Up Space Heat Type <br />(check all fhat epply) <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other �specuynemw� <br />�C. Water Hest Type <br />(cheek oneJ <br />❑ Electric <br />❑ Gas <br />❑ Othef (specirybelow) <br />This bufld(ng meets the WSEC Compllance Method Date of Permit Application �o -1 Z- 95 <br />� Eleclric ❑ Prescriptive Palh Dale Buiidinq Permit Issued r_.� �-�%S <br />❑ Other Fuels ❑ Component Performance Date of Insulation Inspeclion � S-4 S <br />requlrements of the WSEC. ❑ System Analysis Date of Final Inspection Z-S -4 � <br />1 here6y cerilty fhat thls building or addltion has been inspected /or the measures requl�ed <br />by tne 1991 W shington 5tate� Energy Code (WSEC), that itls (n substantlal complianre <br />wlr��f�e WS�, and�t tlte�4VSEGc �cklist lor thls b�ing i� n!i� /' I <br />/ / / <br />Siqnature �f Building ORicial or <br />Dale <br />Return white copy lo• Kathleen Skaar Washinglon State Energy Oltice, 809legion Way SE, FA-11, Olympia, WA 98504•1217 <br />� WSEO • Whife Copy Ufility/Owner - Canary Copy Jurisdiction - Ponk Copy <br />7�92 <br />