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i <br /> KAHN .TON <br /> coo . Building Record "`��' � g <br /> WSEO Contract# <br /> PROG <br /> (please check one) (please check one) <br /> N New Building ❑Addition over 500 sq. tt. 14 Single Family ❑Duplex <br /> Jurisdiction =VP rp f-1 ❑Multifamily ❑Zero Lot Line Home <br /> Planned Unit Development <br /> please check one,- ® City ❑County Permit# r q2 7 h Z <br /> File ID#(it different from Permit#) <br /> QCMNSTRUUTJ <br /> A. Site Information B. Owner Information <br /> Address Ownerrowrerarbmeorcons&twtbnrecelvesubl#ypaymena <br /> 2�OR - I sl S r <br /> city r...,e -.-1 Zip 9& r/ Company L <br /> Asses sor'sPropeltyTax#/oraffachleoaldescnpdon): Address p.r,, r,X 2266 <br /> sj L49-(Mz-on2 -t7OfJZ City r=I/P to d State A)4 zip 5! 2a3 <br /> Servicing Electric Utility D ) )) rll d` ( -e(dAf Phone ( 2u ) ,3-5s -q?2S <br /> Federal IN 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 .1147 sq. ft Total #of Units <br /> Second Duplex Unit sq. ft total sq. ft. (optional) <br /> A. Primary Space Heat Type B. Back-Up Space Heat Type C. Water Heat Type <br /> (check one) (check al that apply) (check one) <br /> ❑ Electric Baseboard ❑ None ❑ Electric <br /> c2L Electric Wall Heater ❑ Wood ❑ Gas <br /> ❑ Electric Furnace ❑ Electric Baseboard ❑ Other(specify below) <br /> ❑ Electric Heat Pump ❑ Other(specify below) <br /> ❑ Other — <br /> This building meets the WSEC Compliance Method Date of Permit Application <br /> I • �z-93 <br /> 9 Electric ❑ Prescriptive Path Date Building Permit Issued <br /> ❑ Other Fuels Component Performance Date of Insulation Inspection 3.j '9I <br /> requirements of the WSEC. ❑ System Analysis Date of Final Inspection y9 <br /> I hereby certify that this building or addition has been Inspected for the measures required <br /> y the 1991 Washington State Energy Code(WSEC), that It Is In substantial compliance <br /> h the WSEC, and the WSEC checklist for this building Is on file. <br /> 2[Signmu, I Building 011icial or Authorized Representative Date <br /> Return white copy to: Kathleen Skaar, Washinglon Slate Energy Office 809 Legion Way SE, FA-11, Olympia,WA 98504-1211 <br /> WSEO• While Copy ulditylowner•Canary Copy Jurisdiction-Pink Copy <br /> 7.92 <br />