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,� — <br /> W� �uilding Recor� ��# � B <br /> �� <br /> ;� CLASSIFICATION � <br /> (please check one) (Please check one) <br /> ❑New Bufiding 0 Addition over 500 sq.ft. 0 ugifamay iIY❑0 o Lot Line Home <br /> Jurisdiction� �,Ct/� <br /> ❑Planned Unit Develo ment <br /> piease cneck one• 0 City ❑Counry _ Permit# `J� — <br /> File ID # il diHeren�Irom Permit _ <br /> ��.� �k: CON�TpUCT10M ��:; <br /> �r f <br /> A. Site information B. Owner Information <br /> Address Z// 7 — � � Owner (owner at tlme ol wnstn�cbon rc�ei�es u���YPaY�^B^U <br /> �G/�.C%4s1L� <br /> Citv �VPr/� tt Zi ZOl �omP�— <br /> Assessor'S PrOpBrty Tax#(ar attach legal descri non) : Address %�y 11.�7� n�F� -- <br /> L�22f1'�30, 8/�voD L�/on�r141�[v2 Cit �c�-f� Stat �� Zip �yQ`�'�'�y'� <br /> Servicinq Electric UtilitY /lJ O/MYY!l6{� Ca �U J� Phone ( 2G���laS Q 7C��— <br /> Federal ID#or SSN <br /> C. If Single Family,Zero Lot Line or D. If Multffamily(R-1) <br /> Planned Unit Development Total#of Buildings <br /> Total Conditioned Floor Area �'2.`s9.ft. Total#of Units <br /> Second Duplex Unit sq_ft_ Total sq.ft. (o tional <br /> " I�AT S�lRCE ` `'"'� � <br /> ��„ , � <br /> A. Primery Space Heat Type B. Back-Up Space Heat Trpe C• WP�o�aHenec o�ne) <br /> (cheek one) (opfional, check all that app y) <br /> ❑ Electric Baseboard ❑ None '�Electric <br /> [�Electric Furnace ❑ Wood ❑ Gas <br /> ❑ Electric Heat Pump ❑ Electric Baseboard ❑ Other�speciry beiow� <br /> ❑ Other (speafy below) ❑ Oth?r(specity below) <br /> �E INSPECTIONIEMFOM�Eai'. = <br /> WSEC Compliance Method Date of Permit Application (0 �� Z <br /> Q�Prescriptive Path Date Buildinq Permit Issued �� <br /> ❑ Component Performance Date of Insulation Inspection <br /> ❑ System Anatysis Date of Final Ins ection _ __ ___ <br /> 1 hereby certily thaf this building or addltlon has been lnspected(or the measures requl►ed <br /> by the 1991 Washington State Energy Code(WSEC), that!t is ln substanflal compliance <br /> with the WSEC,and that the WSEC checklist/or this building is on/ile. <br /> Signature ol Building OHicial or Authorized Representative Date <br /> Retum white copy to:_Kathieen Skaar, Washington State Energy Otiice, 809 Legion Way SE,FA-11, Olympia,WA 98504-1211 <br /> � WSEO�Whife Copy Utility/Owner-Canary Copy � Jurisdiction•Pink Copy g-g� �, <br />