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� � T�`\ <br />� <br />� �. <br />� R <br />��� �� <br />Bui�ding Record <br />Aitadiment B <br />: ; . ,: .: . .., �. �, c :: _ .::.'S <br />nE �.:� �q h R <br />� �� � � <.:�..., Uf�AtDS�/'14�':E� .......� :. ' <br />.. '.: ; .. , , �. <br />.,t . : � ..::', . .;, . .;: ....;::iYs <br />(please check oneJ <br />❑ New Buiiding �Addition over 500 sq. ft. <br />Jurisdictien: �� ,�,'' � t/i�; � � <br />please check one: II CI�Y ❑ COUf1tV _ <br />A. Site Iniormation <br />Address %h'��L Xii, ��JP !•i/ <br />CitV I` ,�;�'1�: r� �b�/�� ZiD :[�.=P13' <br />Assessor'S PfOpBRY TdX #(oi attach le_oal desaiption) : <br />Servicinq Electric Utilitv <br />C. If Sinale Family, Zero Lot Line or D. Dupiex <br />Planned Unit Development First Duplex UnR <br />j n�,!i 1. I. „ <br />A. Primary Space Heat Type <br />(check one) <br />❑ Electric Baseboard <br />� Electric Wail Heater <br />❑ Electric Furnace <br />❑ Electric Heat Pump <br />❑ Other <br />(p/ease checA one) <br />�Q Single Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit # R?X i b 5 <br />FI�B �� #(it diNerent lrom Permif A1 <br />B. Owner Intortnation <br />OWI1Bf (owneratOmeo/construcdon�ecei�suh7ityp3ymert) <br />�ir�'�. l�nn- W„:n� <br />Com an <br />Address N �C1 Z- r'"!� ���.�/ � <br />Citv 5= ✓� i r N State'�✓, % Zip �� GS;- <br />Phone ( � ':'„ ) ; �; : - %,3�r?s' <br />B. Secondarv Space Heat Type <br />(check all tFaf app/yJ <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other (specilybelow) <br />ft. <br />E. If Multifamily (R-1; <br />Total # of Buildin <br />C. Water Heat Type <br />(check oneJ <br />❑ Eledric <br />❑ Gas <br />❑ Other(spec�iy�iow� <br />�, � a� [.�.� ��a �p n „ �y���<: > ., & .:� <br />,: ry : ,... `:..�ilEE�1��. :3 �' `�< . .' 11Fi��S�i1��W���ii1{.� .?_>.,:z�.�.3 <br />� . ..:, . ......: <br />�lor Heat Pump OnFy� <br />WSEC Compliance Method This building meets the Date of Perrnit Application -j ;; �; -;,,_ <br />� Prescriptive Path � electric Date Buildinq Permit Issued �- I I- 93 <br />❑ Component Performance ❑ other fuels Data of Insulation Inspection �l ��� i�.3 <br />❑ System Analysis requirements of the 4VSEC. Date of Final insqeciion �) 2 °�-j <br />I hereby certify that this building or addition has been inspected for tF�e measures required <br />by fhe 1991 Washington State Energy Code (WSEC), that if is in substanfial compliance <br />� with the WSEC, and that the WSEC checklist for this huilding Is an file. ., <br />� <br />� �. .-! i i. ii�, �'.�.. < --� I < i <br />of Building OHicial or Authorized Representative <br />Date <br />Return canary copy to the servicing electric utility to trigger WSEC compliance payment � <br />Return whHe copy to• Kathleer 'kaar Washington State Energy 0flice P.O. lox 43165, Olympia, WA 985043165 �2-9z ! <br />WSEO - White Copy Ufilify/Owner - Canary Copy Junsdiction - Pink Copy ' <br />