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�� r�Y <br /> WASHINGTI�N -- � �" , �' <br /> � �uilding Record �:o�t# A� B <br /> �oc�nn <br /> `i b. � � � .>� » f �Q �u-@ 3��a°E. p�tt�{��V �q u o..�r .5 :,� �.s n k ie � . �> r a:, �` i'+y <br /> �4�'S �.��.. � � ts'� + a�.�'F �>��x�.? i.YLMt3A'T���. .. ,.�'3� u'Sx&�.<:: i�� M�`q� ;i <br /> (please check one) (p/ease check one) <br /> �,New Buildi /❑Addnit(on over 500 sq.ft. �Single Family ❑Cuplex <br /> IJurisdiction: �y�� D t' ��� ❑Multifamily ❑Zero Lot Line Home <br /> ❑Planned Unit D velo ment <br /> please check one: CitV ❑CountV Permit# .3L0 <br /> I ��, FIB ID#Dt d�Nerent Irorn PermrtAl <br /> �fiY"`�S�'Y a�' t J C'f°x, F .1 h c�.♦ {� i.,n '�..Y ,.t`.?�y.�x��H� .4 � ai F < S �� 4. ! �� �° '��' <br /> ��.`•`�`yM;3Y_ ;^�S ryC i z a '�.�c y .$ 2 � [] e[(� x : . Y k,rb.a.,:.tr. � a r�1;:.� i'�,Y. 't <br /> y�...: � . , ..... G ....< ��wY����'�\Y��� v... '.. >ie . .. . .. <br />� � A. Site lnformation B. Owner lntorm ation <br /> IAddrBss `�// - 12�� —Owne� �o—wn�e—ra�tom3olconsvuc' nrecei�ssutili vnern <br /> � �) /1 n�i%12 <br /> CitY J�fi�" Zip r/r�'/ CompanV , <br /> Assessor's Pro ert Tax# or attach 1 ai desc.i non : Address /l �� <br /> - - /'� -OOGLS" Citv �L,� State � Zi � <br /> Servicinq Eledric Utilitv Phone ( 20C� 1 ��� � �.511� <br /> C. If Single Family,Zero Lot Line or � D. Duplex E. If Multitamily(R-1) <br /> Planned Unit Development Flrst Duplex Unit sq.ri. Total#of Buildings <br /> ' Total Conditioned Floor Area/yo1 sq.ft. Second Duplex Unit . ft. Total#of UnRs <br /> � i �m;« x r� 6 'f`x.^��^ < �•�{ y!2r3�r �e..a��{"y�.n�ca .�' w r�C3�.ae+�r.hu.r^c, x�,i, YC�°" £�""` .� <br /> �aYf : ( 5 J?.S a'is�f ��`l�k.i�� � <R... � ; � ea.l."S <br /> ki... ..a.� ..:+� r <br /> A. Primary Space Heat Type B. Secondarv Space HeatTy�x: C. Water Heat Type ' <br /> - � (checkoneJ (cHeckalltfiatapplyJ (checkone) <br /> ❑ Electric Baseboard None Electric <br /> � �Electric Wall Heater ❑ Wood ❑ Gas <br /> ❑ Electric Furnace ❑ Electric Baseboard ❑ 01her(spea�ybe�uw� <br /> � ❑ Electric Heat Pump ❑ Other(sPecrtynerow� <br /> i ❑ Other <br /> p..er ^.m «s^�� mr,Mn,n4x s mK :am £' .�. r r..� "<+�E �'Sfs,,� �4M"w.»"':. „`�:`mT s':�?3%'m"� <br /> � �"h § i.�cl (��{{� fr�. ..h, � 3 p�yt �y� 7� <br /> �,��.i¢F�,...n�?.<.,_>'�� ��G'd/U�� .ai �""r y s'N ,E����Q��f/[1i��ifl{�'4`�'y <br /> II x.� ��:a:.ea�.t..,2.<n .:< .3 ,.,� F. <br /> (IarHea�PumpOnly� • .. .:. .... . <br /> I WSEC Compliance Method This building meets the Date of Permit Appiication ,S/7-9,5 <br /> Q�,Prescriptive Path �electric Date Buildina Permit Issued ti-13-QS <br /> ❑ Component Perfortnance ❑ other fuels Date of Insulation Ins ection <br /> ❑ System Analysis requirements of the WSEC. Date of Final Inspection -Z9-Q5 <br /> I hereby certify that this building oraddition has been inspected for the measures required <br /> by the i991 Washington State Energy Cnde(WSEC), that it is!n substantial compliance <br /> "th fh WSEC, a d lhat the WSEC checkllst for this bui/ding is on/i/e. <br /> � i� � <br /> ISigna e of Buil�ng OMcial or Authorized Representa6ve Date � <br /> I <br /> � Retum canary copy to the servicing electric utility ro�rigger WSEC compliance payment <br /> I Return whlte copy to: Kathleen Skaar Washington State Energy Office, P.O.Box 43165 Olympia,WA 98504-3165 �z�9z <br /> '� WSEO-NMite Copy Utllity/Ownei�Canary Copy Jurisdiction-Pink Copy <br />