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�I�V' -IINGTON , -. <br /> � Building Record ,,,��# "'� ' <br /> �� <br /> rtT � �f;'� 4 * �.xwL��� '_ ,. ���� � � �� <br /> t k <br /> (please check oneJ (p/ease check oneJ <br /> 0 New Building ❑Addition over 500 sq,ft. ❑Single Family �Duplex • <br /> Jurisdiction: ❑Multifamily ❑Zero Lot Line Home <br /> — ❑Planned Unit Development <br /> a�ease a,eck one: '� Citv ❑CounN Permit# " <br /> FIIB ID#(i!dil/erent Irom Permit A1 <br /> ���i "�"��lM � � <br /> � � �� h ` ��. <br /> A. Site Information B. Owner Information <br /> Address- ' -_ � , 1 Owner /a+ner ar 6me o�mnsm,ction recehes uti�,p,�nt1 <br /> " — <br /> ',i�.tr� i;l�.;t.�:i — <br /> Clty •• •.. , ZIP "' .'�° COffIP8f1V <br /> ASSBSSOf'sProp9rtyT8X#forattachlegaldescripfioni ' Add�eSS 1:'%3::1' �t'��'"Ff,y p ,��:• �;�� <br /> �:�., � ��' ,..iti! lu���.�(r� <br /> CI�V ' i� '''�I��(� $18TE ''A ZID u.,.. ,r <br /> Servicinn Electric Uhlity '';�� c ^r, Phone ( ' !�n � v _�- �5n7 <br /> Federal ID#or SSN <br /> C. If Single Fam(ly,Zero Lot Line or D. If Multffamily(R-1) <br /> Planned Unit Development Total#of Bwldings <br /> Total Conditioned Floor Area sq ft Total#of Units <br /> Second Duolex Unit sq ft Total sq.it. (optionap <br /> �I.9'Yil ����ir,� ���I, ' �!'� t�'�� ~�� i'a��� . A.�J ���T✓j;�k. <br /> 1 i � � � x� <br /> A. Prfmary Space Heat Type B. Back-U�p Space Heat Trpe C. Water Heat Type I� <br /> (check one) (opflona,check all that app y) (opt/onel,chxk one) <br /> ❑ Electric Baseboard ❑ None '� Electric <br /> ❑ Electric Furnace ❑ Wood ❑ Gas <br /> ❑ Electric Heat Pump ❑ Electric Baseboard ❑ Other�spec�ry neaw) <br /> � Othe� (spedly below) L.� Oth@f(specily belowJ <br /> , �7^ �,,.1q�p.17.. <br /> �� .��� ��� �"� <br /> , <br /> WSEC Compliance Method Date of Permit Application "s-1 1-"�:� <br /> ❑ Prescriptive Path Date Building Permit Issued �'- � � <br /> ❑ Component Performance Date of Insula'ion Inspection '� <br /> ❑ System Analysis Date of Final Insoection . ; <br /> l hereby cerf!/y that th/a building or addlt/on has been lnspected/or the measures requlred <br /> by the 1991 Washington State Energy Code(WSEC), thaf It!s!n substanNal compflance <br /> w/th fhe WSEC,and that the WSEC check/!st/or thls bul/ding!s on/!/e. <br /> Signature of Buikling Oryiaal or Authorized Representative Date <br /> Retum white copy to: Kathleen Skaar, Washington State Energy pffice, 809 Legion Way SE, FA-11, Olympia, WA 98504-1211 <br /> WSEO-White Copy Utility/Owner-Canary Copy Junsdiction-Pink Co <br /> PY 6-91 <br />