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Building Record <br />(p/ease check one) <br />❑ New Building f2�t Addition over 500 sq. ft. <br />Jurisdictian• �� an Fl <br />p/ease check ane• � City ❑ COUntV <br />A. Site Intormation <br />Address <br />Z5f0- 7y"Sl- <br />rn, ����p�{ Zip 9�20/ <br />ASSOSSOf�S PfOpBRV T2X #(oiatlach leoal description) � <br />yq�l -r�no-04R�xnG _ <br />Servicina Electric UtilitY a.!/ i), aI r� Sn�tu;,N;�GCn <br />C. If Single Family, Zero Lot Line or <br />Planned Unit Development <br />Total Conditioned Floor Area (0 /3 sq. ft. <br />Second Duplex Unit sq• ft• <br />A. Prfmary Space Heat Type <br />(check one) <br />� Electric Baseboard <br />❑ Electric Wa11 Heater <br />❑ Electric Furnace <br />❑ Electric Heat Pump <br />❑ Other <br />WSEO Cotttract <br />(please check one) <br />� Single Family ❑ Dupiex <br />❑ Multifamiiy ❑ Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit # C y I 137 <br />File ID #(if dillerent lrom Permit #1 <br />Attachme►� B <br />B. Owner Information <br />Own�f �(ownerattimeolcronsWdionreceivesufi(rtypavmenQ <br />Com an w <br />Address a51 - y'^ 1 <br />CitV F�p -�y State (.Jrl ZiP 9Fd01 <br />Phone ( zG(n ) zs��- 7q53 <br />Federal ID# or SSN <br />D. It Multifamily (R-1) <br />Total # of Buildings <br />Total # of Units <br />Total sq ft (optionap <br />B. Back-Up Space HeatType <br />(check al1 that apply) <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Olhef (specilybelow) <br />' C. Water Heat Type <br />(check one) <br />❑ Electric <br />❑ Gas <br />❑ OthBf (specifybelow) <br />.�;�^,�.. , , � -'-"- �-w��`'Y"' a��`' NI SPECTION'/ENFORGEMENTl,�r�:a�'=; <br />,� .�..,,�;`'�`���C�OMALIANCE {s��, � �.`-� <br />This building meets the WSEC Compliance Method Date of Permit Application [o-2G -93 <br />fl Eleciric � Prescriptive Palh Date Buildinq Permit Issued 7- 3G -_� 3 <br />❑ Other Fuels ❑ Component Performance Date of Insulation Inspection �-ll� -G-3 <br />requfrements of the WSEC. ❑ System Analysis Date of Final Inspeciion li)-�-1-�i 3 - <br />1 hereby certily that this building or addition has been inspected lor the measures required <br />by the 199Y Washington State Energy Code (WSEC), ihat it is in substantia! compliance <br />���d�it� the yVSEC, a�h^t the WSEC checklist lor this building is on,lile. / <br />-7 /� �. G, <br />Olficial or Authorized R^presenfative <br />Oate <br />Return white copy to: Kathleen Skaar, Washin9ton Stale [nergy Office, 809 Legion Way SE, FA-11, Olympia, WA 9850�1-1211 <br />� WSEO - While Copy U(ilify/Owner - Canary Copy Jurisdiction - Pink Copy <br />7-92 <br />