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� � <br /> H <br /> ryxyy . <br /> HxH <br /> fC C] <br /> H � <br /> �� � <br /> y y�i W � l�� 64W1 rs,....a <br /> �� `d ���� Buildir�g Record ,�o�# "`�"` B <br /> �� g �oGR,ann <br /> � y� ,'; CLASSIFICAT�N : " ''�� <br /> HH <br /> �y F� (please check one) (please check one) <br /> �c�+� qNew Buliding ❑Addition over 500 sq.tt. 0 Single Family ❑Duplex <br />, � �"� �j Jurisdiction: ❑Multifamily ❑Zero Lot Line Home <br /> y p y ❑Planned Unit Development <br />' piease cnock one: ❑ City ❑Counly Permit# <br /> File ID#(ildiflerent from Parnit�ry <br /> i 5�,.��j��.S `�J 3 � . T r w�___ .�■���y�� . .t. .�� }, ., "y.y.1�,.�] <br /> . G.'^�;�5'��.Aidkr:'1'•'`,.�' Y `f ".'J Ri.: " _�..'YY���1� ..�'(_ 15��" {!�1�.^�v� <br /> A. Site Informetlon B. Owner Information <br /> Address - Owner (rnvnerattlmeo/cvnstnlch'onreceivasu6lMPaYmenp <br /> CitV Zip Company <br /> Assessor'S PropertV TaX#(or attach lega/description): AddfeSS <br /> Citv State Zip � <br /> Servicing Electric UtilitV Frune ( ) <br /> '�t Federal ID#or SSN � __ ___ <br /> 1�' C. If Single Family,Zero Lot Line or D. If Multifamily(R•1) <br /> Plansied Unit Development Total#of Buildings <br /> � ' Total Conditioned Floor Area -�:f �.ft Total#of Units <br />, 1 f Second Uu�lex Unit _ sq_ft._ Total_sq.it. (optiona�_ _ <br /> � <br /> -' `� `' l�AT SOURCE _ <br /> I � A. Primary Space Heat Type B. Back-Up Space Heat Tvpe C. Water Heat Type <br /> i � (ehaek one) (opflanel,eheek all fhaf apply) (optlonal, eheck one) <br />� 1 � Electric Baseboard � None ❑ Electric <br />� ❑ Electric Furnace ❑ Wood ❑ Gas <br />�i ' ❑ Electric Heat Pump ❑ Electric Baseboard ❑ Other(soecily be�ow) <br />` Es1 ❑ Other ispecity br.row) ❑ Othef(specilyGelowJ <br /> f <br /> I tY'I <br /> .... . . .. . . . . . . . . <br /> I t� _ �rOMPLlAqCE INSPECTI�IIENFORCEII�NT <br /> il ' WSEC Compliance Method Date of Permit Application <br />, , ❑ Prescriptive Path Date Building Permit Issued <br /> � Component Periormance Date of Insulation Inspection <br /> ❑ SysPem Analysis Date of Final Inspeclion <br /> I here6y cert!/y that th/s bullding or add/tlon has been lnspected for the measures requlred <br /> by the 1991 Washington Stafe Energy Code(WSEC), that!t!s in substanNal compllance <br /> with the WSEC,and that the WSEC checklist for this building is on/ile. <br /> ISigra:we ol Building 011icial or Autharized Representative � Date <br /> Return whlte copy to: Kathleen Skaar, Washington State Energy Office, 809 Legion Way SE,FA-1 t, Olympia,WA 98504-1217 <br /> — ----- — — ----- -- --- ---_. _-- --- — --� <br /> WSEO-WhiteCopy Uti'ity/Owner-CanaryCopy Jurisdiction-PinkCopy 6.�� <br />