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is NO <br /> W HINGTDN irnerd <br /> 4-40-`19, <br /> �� Building Record A�,I <br /> y WSEO Contract <br /> o to PROC'RAM <br /> CLASSIFICATION_ r L <br /> K0 (please chock one) (please cheer:one) <br /> p� 0 ❑New Building ❑Addition over 500 sq.ft. ❑Single Family ❑Duplex <br /> HJurisdiction: El Multifamily [I Zero Lot Line Home <br /> En H <br /> z H ❑Planned Unit Development <br /> �y C please check one city Permit J! <br /> 00 H File ID If(if different from Permit a) <br /> " g <br /> CONSTRUCTION j <br /> zH -- --- - -- - - -- <br /> y x B. Owner Information <br /> H y A. Site Information _-__--- - - <br /> grn H Address Owner I w x ,t nmo of mrektrc0o race vas u dly paymenrl <br /> n t7 ti _- <br /> City Zip Company - - -- -- <br /> ,zy yo y Assessor's Prdperty Tax If(or atfaCh legal desa�ptom: Address <br /> City State Zip <br /> Servicing Electric Utility Phone ( ) -_— <br /> Federal IDN or SSN <br /> C. If Single Family,Zero Lot Line or D. If Multifamily(R-1) <br /> Planned Unit Development Total a of Buildings <br /> Total Conditioned Floor Area sq.ft. Total tr of Units <br /> Second Duplex Unit sq ft- Total sq ft. (optional) <br /> HEAT SOURCE <br /> A. Primary Space Heat Type B. Beck-Up Space Heat 7Y C. Water Heal Type <br /> (check one) (optional,check all that appy (options$,check one) <br /> ❑ Electric Baseboard ❑ None ❑ Electric <br /> ❑ Electric Furnace ❑ Wood (] Gas <br /> (�.� ❑ Electric Heat Pump ❑ Electric Baseboard ❑ Other(specify below) <br /> ❑ Other (spears below) ❑ Other(specify bolos, <br /> t COMPLIANCE INSPECTIONIENFOhCEMENT <br /> t I_� WSEC Compliance Method Date of Permit Application <br /> Cl Prescriptive Path Date Building Permit Issued _ _ <br /> ❑ Component Performance Date of Insulation Inspection -_ - <br /> ❑ Systom Analysis Date of Final Inspection <br /> I hereby certify that this building or addition has been Inspected for the measures required <br /> by the 1991 Washington Stare Energy Code(WSEC), that it Is in substantial compliance <br /> with the WSEC,and that the WSEC checklist for this building is on file. <br /> signature of Building Official or Authorized nepresentatvo nate <br /> Return white copy to: Kathleen Skaar, Washington State Energy Office, 809 Legion Way SE,FA 11. Olympia,WA 98504-1211 <br /> WSLO- white Copy utility'Uvner-Canary Copy Jurisdiction-Pink Copy g.g1 <br />