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W HINGTON <br /> CODE Building Record WSE0 Contract# Attachment B <br /> PROGRAM <br /> e25 check one) (please check one) <br /> L9 New BuIlding Additfon over 500 sq. ft. '❑Single Family ❑Duplex <br /> Jurisdiction: i Tr U(/t Fes/ ❑Multifamily ❑Zero Lot Line Home <br /> iv ❑Planned Unit Development <br /> please eck one: O'City ❑County Permit# �(,) <br /> File ID #(if different from Permit#) <br /> "l) <br /> A. Site Information B. Owner Information <br /> Address -JT t Owner (owner at time of constriction recehvs utility payment) <br /> City Zip ZC13 Com an <br /> Assessor's PropeTax # orar hlegaldescriittionL__ Address <br /> lZd /4/-� Cit State Zi <br /> ServicingElectrcUtiiity �Snp a Phone <br /> Federal ID#or SSN <br /> C. If Single Family, Zero Lot Line or D. If Multifamily (R-1) <br /> Planned Unit Development Total #of Buildings <br /> Total Conditioned Floor Area A&V sq. ft. Total#of Units <br /> Second Duplex Unit sq. H. Total sq. ft. (optional) <br /> MENEEMW W_ <br /> o a <br /> A. Primary Space Heat Type B. Back-Up Space Heat Type C. Water Heat Type <br /> (check one) (check at that apply) (check one) <br /> ❑ Electric Baseboard ❑ None 9-fiectric <br /> 0 Electric Wall Heater ❑ Wood ❑ Gas <br /> ❑ Electric Furnace ❑ Electric Baseboard ❑ Other (specifybelowl <br /> ❑ Electric Heat Pump ❑ Other(specify below) <br /> ❑ Other <br /> 1192EFMNELUQMPEIANG��� 10 MINSTrUMMORCEME <br /> This <br /> ,.,.,b�u �Ing meets the WSE Compliance Method Date of Permit Application <br /> CJ Electric Prescriptive Path Date Building Permit Issued 16 <br /> ❑ Other Fuels ❑ Component Performance Date of Insulation, Inspection 9-13- 5 <br /> requirements of the WSEC. ElSystem Analysis Date of Final Inspection /I- Z I-ql <br /> I hereby certify that this building or addition has been Inspected for the measures required <br /> by the 1991 hingfon S�fe Energy Code (WSEC), that It Is In substantial compllanre <br /> wit a and f e WSEC checklist for this building Is on file. <br /> Signat of Bwlding 011icial or Authorized Representative Dale <br /> Return white copy to: Kathleen Skaar, Washington State Energy Office, 809 Legion Way SE, FA-11, Olympia,WA 98504-1211 <br /> WSEO- Whim Copy Uldity/Owner-Canary Copy Jurisdiction-Pink Copy <br /> 7 9t <br />