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��� <br />ay <br />,o�x <br />�x� <br />HZ� <br />�H� <br />�CnH <br />[�1 O tl1 <br />Hl7 <br />OH <br />��o <br />(1] V �] <br />aH� <br />t.'HH <br />� <br />��m <br />tTl t' <br />t� <br />HO[�i� <br />''� s <br />�� � �� <br />� <br />�� <br />! 1�� <br />S ATE G� <br />EN�RGY <br />P�OGR�M <br />��ilding i�e�ord <br />(please �heck one) <br />❑ Plew Buflding Q Addition over 500 sq. ft. <br />- r <br />Jurisdictio� � ' ' `''-� <br />--- ❑ Cit ❑ Count --- <br />lease check one: <br />A. Site Informalion \) � <br />�� .:?.1 \�_ ._' I�"�-. - <br />ndd�ess--'— ; .,� zc��;_ <br />- _�- �_ �r- -y-.-�--- <br />Cit - _ Zi <br />Assessor s Prope� Tax #�or att�cn ieaal descn con :_ <br />� • ' 1 s ' =,�t�C ' . _.u- r-�-- <br />-- ---• <br />Servicing Electric _U i y _ __ <br />- <br />---- _ <br />C. If Single Family,'ero Lot Line or <br />planned Unit Development ` _ ____ <br />- — ,', sq. it <br />Total Conditioi)_ed_Floor Area _ . �'�- _Sq, �l._ <br />D lex Unit — — --- <br />Attacf�ne� B <br />WSEO CoMract #__-- <br />(please check one; <br />.� Single Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unil Development __ - ---- <br />Permit # _,=r:1��-Z-- <br />File ID # ildifle�entlromPermit <br />_ _. _._.,_.� n--.�ae.� <br />B. Owner Iniormation <br />OwnO� ownerattimeolconsW�ionreceivesutil� a ment <br />G i1_p�— - ---� <br />com an __- . _ <br />Address ',� �D � �'= ��'-� <br />State n Zip •� �- S' <br />City_ _ei_�_:_ ' r �,. ,. , <br />Phone ' <br />Federal ID# or SSN _ _ <br />D. It Multifamily (R-1)_ <br />- -_-_ - - <br />Total ii of Buildinys _ _ <br />Total # of_Units _ _ __ <br />Total sq. ft,{oplional) _ _„� <br />� <br />Second _ up __ __ _--- <br />HEAT SOURCE __ . _ __— _— <br />— ------------ — <br />p, Primary Space Neat Type <br />(checkane)_ _ _ ___ - <br />❑ Electric Baseboard <br />❑ Electric Wall Heater <br />[] Electric Furnace <br />❑ Electric Heat Pump <br />❑ Other _ _ ____ _ <br />_ ---- -_ COMPLIAWGE <br />This� b,/uilding meets ihe <br />o I;Q Electric <br />��� ❑ Other Fuels <br />EC <br />B. Bnec oi�inaf epp/ yHeat Type <br />__ <br />❑ None <br />❑ Waod <br />❑ Electric Baseboard <br />❑ OlhOf (speci(yb ow) <br />W SEC C� ethod <br />❑�, JPrescriptive Path <br />� Component Performance <br />❑ Syslem Analysis <br />�, WaterHeatType <br />(check one) _ _ _ <br />❑ Electric <br />❑ Gas <br />❑ OthBt (specitybelowl <br />__ __ - <br />INSPECTlONIENfORCEMEN__ T___.�-� <br />Date ol Permit ApPlication _- - �-_ ?,='— <br />_ _ %' --- <br />Date Buildirg Permit Issued _ -7 ` <br />`� � ' �-�-� - <br />Date of Insulation Inspection_ <br />Da[eofFinallnspection � ? �.�-�-�--- <br />requirements ot the WS • <br />1 hereby certily that this building or addltion has been Inspected for the measures required <br />pv the 1991 Washington State Energy Code (WSEC), that it is in substantlal comp��an�e <br />� wpb lhe WSEC and that the WSEC checklisf for this building is on �i�e ,_, _ <br />�. <br />, � *' - - _ _ <br />, , , >- -- <br />L _>-_ <br />-- '.._ -- - Date i <br />i 7 . <br />Signalure o� Building O��icial or ANhur¢ed Repres�ntative 9Y � \n/q g8504-1211_ _ <br />- - Ju�isdiction - Pink Copy <br />to: _ Kathleen Skaar, Washin ton State Ener Otfice, 809 Legwn Way_SE, FA-17. O ympm, � <br />9 . _ __. . . - � <br />ReWmwhilecopY _._ _-.-. --_._... UlilityiDwne�-CanaryCopY 7�92 <br />� - � WSEO � Whife Copy <br />