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W�� . <br /> �� Building Record ,,,�,�# ^� B <br /> CLASSIFICATION , <br /> (please check one) � <br /> 0 New Building ❑Additlon over 500 sq.ft. (P�ease check one) <br /> Jurisdiction: ❑Single Family ❑Duplex <br /> �Multifamily ❑Zero Lot Line Home <br /> please check one: ❑ CItV ��n�� fi �P�anned Unit Develo ment <br /> — --' Permit# <br /> FIIB ID#(i1 diNerent/rom Permit A� <br /> . <br /> CONSTRUCTION <br /> A. Site Information <br /> Addre B• Owner Information <br /> �-- <br /> Owner (amer at fime o/consryucry'on receives u6TM nav�� <br /> Ci — Z—�-- <br /> Assessor's Propertv Tax#i �� �, �—°mLa�Y__ <br /> descrip(ion): _ AddfeSS <br /> Servicinq Electric Utilitv �—��-- ' State <br /> ------. Phone Z�p <br /> ( � <br /> Federal ID#or SSN <br /> C. If Single Family,Zero Lot Line or <br /> Planned Unit Development �• If Multifamily(R-1) <br /> Total Conditioned Floor Area Total#of Buildings <br /> Second Di� lex Unit S . ft. Total#of Units <br /> S� Total sy. ft. o tional '--- <br /> HEAT SOURCE <br /> A. Primary Space Heat Type <br /> �cneck one� B. Back-Up Space Heat Trpe <br /> (op�lonal, check all thet app y) �• Water Heat Type <br /> � ElectricBaseboard (oprionai checkone� <br /> ❑ Electric Furnace � None ____ <br /> ❑ Wood � E�ectric <br /> ❑ Electric Heat Pump ❑ Electric Baseboard � Gas <br /> ❑ Other (speci.'y below) ❑ Other(specily be/ow/ . <br /> ❑ OIhEf(specily be/owJ <br /> �M��E INSPECTION/ENFORCEMENT <br /> WSEC Compllance Method <br /> ❑ Prescriptive Path Date of Permit Application <br /> ❑ Component Performance Date 8uildin Permit I euss d_---------- <br /> ❑ System Analysis Date of Insulation Ins ection j � - — <br /> Date of Final Insoection — <br /> /hereby cerP1/y that th/s bullding or addlHon has been lnspected/or the measures�equJred <br /> by the 1991 Washington State Energy Code(WSECJ, that!t is/n substanNal compl/ance <br /> with the WSEC,and that the WSEC checklist Ior this build/ng is on!ile. <br /> Signature ol Building Oflicial or Authorized Representative —�-- _ <br /> Date �� <br /> Return white copy to:_Kathleen Skaar, Washinglon State Ener <br /> WSEO-WhiteCopy ----__ 9Y�Kice, 809LegionWaySE, FA-11, Olympia, WA 98504-1271 <br /> U(ilify/Owner-CanaryCopy --� –--- -- <br /> Jurisdiction-Pink Copy 6,91 <br />