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� �� �� <br /> W��G1UN AttaCMient B <br /> �� B�ilding Record �o���# <br /> ��� <br /> (pl ase check one) (please check one) <br /> �New Buildi Addil(on over 500 sq.ft. (�.Single Family ❑Dupiex <br />� Jurisdiction: v{- f J.ut-E7`� ❑Multifamily ❑Zero Lot Line Home <br /> ❑Planned Unit Develo ment <br /> piease cneck one• City ❑Countv Permit# � 3/ •�. <br /> File ID#(ildiHerentlrom Permit il1 <br /> A. S(te iniormatlon B. Owner Information <br /> � � � . AddresS — '�" Owne� ownerat6maolcanswcaonreceivesuBl' ment <br /> To n ,��;��-�'f <br /> CitY IPr'-2ff" Zip � �'�/ Com��n <br /> Assessor'S Pfo ert TaX#(ar attach leoal descrip:ion�: AddfeSS / � 3l "o/��� g✓� — <br /> 3 ?-B�?9 -C/7 - oGY>S Ciry �,!,�raf� State�<1.4� Zip 9'�/ <br /> Servicinq Electric Utilitv C -� J���`� Phone ( ���a ) ��- �S G'O <br /> Federal ID#or SSN <br /> C. If Single Famiiy,7.ero Lot Line or D. If Mult(family(R-1) <br /> Planned Unit Development Total#of Buildings <br /> Totai Conditioned Floor Area / �� sq. ft. Total#of Units <br /> Second Duplex Unit sq. ft. Total sq ft (optionai) _ <br /> A. Primary Space Heat Type B. Back-UP Space Heat Type C' Wn ek o�t Type <br /> (cheek ona) (check al thet apply) _ ( <br /> ❑ Electric Baseboard �None Electric <br /> /�. Electric Wali Heater ❑ Wood Gas <br /> . ❑ Electric Furnace ❑ Elec.-tric Baseboard ❑ Other�specrrybe;ow� <br /> ❑ Electric Heat Pump ❑ Oth2�(specilybelowJ <br /> ❑ Other <br /> ������� <br /> This building meets the WSEC Compliance Method Date of Permit Application S�7-�_ <br /> �Electric ,'�. Prescriptive Path Date Buildinq Permit Issued •.� 23�� <br /> ❑ Other Fuels ❑ Component Performance Date of Insulation Ins ection <br /> requirements of the WSEC. ❑ System Analysis Date nt Final Inspection �Z9-9S <br /> I hereby certlfy that this building or additlon has been inspected for the measure�requlred <br /> by the 1991 Washington State Energy Code(WSEC), that it!s!n substantia/compllance <br /> !th t e WSEC, nd that the WSEC checkllst for this bul/cing Is on lile. <br /> , ^ <br /> Sig ure ol Building Oflicial or Authorized Representative Data <br /> Return white cepy to: Kathleen Skaar, Washington Slate Enargy Office. 809 l.egion Way SE, FA-11, Olympia,WA 98504•1211 <br /> � WSEO•While Copy Ufility/Ov.�ner-Canary Cr.ny Jurisdicfion-Pink Copy <br /> 7�92 <br />