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�,� G�-,� l-�-`� G <br /> �� � Adadrne�t B <br /> ���� Building Record � �o�» <br /> � <br /> o� t�¢�� "o�`A'� . 123�`�`9qa �F:��a '�A o�� <br /> ; •�,��iz�; i- � � '.��`: �� -..,.'��'9.�j'G�\�`�:� a ... . . ���l�r\..a�oc�:���Z\.�����.�. <br /> � .\?.... <br /> (pka check one) (please cheek one) <br /> New Buildin ❑Addkion ver 500 sq.H. ❑�ngle Family ❑Duplex <br /> Jurisdiction: IJ MuRitamily ❑Zero Lat L!ne Home <br /> ❑Planned Unit Develo ment <br /> pea5e�he�c one• Citv ❑Counhi Permit# /� �� <br /> Fle ID#In drnereM�.om aam+n,n — <br /> r i �:.' <br /> ��� ��z�`�`�Aj�g,��� \ � \:... <br /> � �'£ ��•L. r 'SxR 3 �.����a�i�� <br /> R. SHe Intormation B. Owner Intormation <br /> Address � Owner (owmratNneotcros6ucC�nrecei�esuhHYypaYmenO <br /> ,, �;,, � Com an <br /> ��— Address - � � ����r'� <br /> Assessor's Property Tax�(or arcacn Ieoa�dasaianon): State Zi �j�,��_ , <br /> Ci <br /> ServicinqElectricUtiiRv ��YI/J Phone ( 2l'J/o 1 �3y-� 3h <br /> C. If Si,iglr:Family,2ero Lot Ltne or D. Duplex E. If Multifemily(R•1) <br /> Planned Unk Development Firsl Duplex Unit sq.tt. Total#of Buildings <br /> Total Conditioned Floor Area s .tt. Second Du lex Unit .fl. Total#of Unils_�_ <br /> x .. , . . . ,. �. : � .c�. ��,%�� �r� <br /> � � �� <br /> �_,., R� Q �^�r :II�'..^3 c a'� �� . �_ . , . �a. � �': ��.... .� .� ,� ��..••,c,�t��� ,,ira' <br /> ,�'3.�., r .. `k g.i., or l��a.: .. �: . <br /> .'1 U�i.� .��..�C..'5.�;£;,. . E.�.`>o.... ,� i., ..a •' . .. . .... . <br /> A. Primary Space Heat Type B. Secondar�SPece Heat Type C. Waier Heat Type <br /> (ehxk one) (sheck NI t epp1Y1 (chxk om) <br /> ❑ Electric Baseboard ❑ None ❑ Eledric <br /> ❑ Electric Wall Heater ❑ 1Nood ❑ Gas <br /> ❑ Electric Furnace ❑ Eleciric Baseboard ❑ Olher�SPnurybe�ow) <br /> ❑ Electric Heat Pump ❑ Other(specitybeiow) <br /> ❑ Olher <br /> �n� � �.�;� �.� �; ` ����k�l 1�1�� s : <br /> �{�,�,�� '"�����'��`�'��,����;�;: =��a'��� �`�`��; �,� <br /> 3.'�[l'�.'�,^,S a'"i�[ 1, »�.,. hXc�, .. . <br /> � (lo�Hwl Pump OnNI G <br /> WSEC Compliance Method This building meets the Date ot Permit Application � <br /> ❑ Prescriptive Path ❑ electric Date Bwidin PermR Issued -9 <br /> Date of Insulation In ection /G- <br /> dComponent Periormance ❑ othertuels Dateof Final Ins ection — - <br /> ❑ System Analysis requirements o(the WSEC. <br /> I hereby certi/y that thls building or addiflon hes been lnspected/or fhe measures requ(red <br /> by the 1991 Washington State Energy Code(WSEC), that!t!s in subsfantlal compliance <br /> with th WSEC,and thaf W C checklist for this bullding ls on/ile. <br /> _ Z _c <br /> naNre o uilding OKcial or Authorized Representative Date <br /> Return canary^.opy to the sen�icing eleciric utility to irigger WSEC compliance paymenl �Z 92 <br /> Retum whita copy to:Kalhleen Skaar,Wast ington State Energy Office P O Box 43165 Olympia WA 985043165 _ <br /> WSEO•WhiteCopy Utiliry/Owner-CanaryCopy Junsdc�on-PmkCopy <br />