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WASTE <br />IED( NGT <br />ENS, <br />PROGRAM <br />Building Record <br />(please check one) <br />❑ New Building ❑ Addition over 500 sq. ft. <br />Jurisdiction: <br />please check one: ❑ City ❑ County <br />CLASSIFICATION <br />WSEO Contract# <br />(please check one) <br />❑ Single Family ❑ Duplex <br />❑Multifamily ❑Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit # ,f'17,, <br />File ID # (if different from Permit +1) <br />Attachment B <br />_ CONSTRUCTION <br />A. Site Information B. Owner Information _ <br />Address „ — _ Owner lowrreraterneotconeeucewtrecavesueNvpayment) <br />City --- Zip -- Company , -- <br />Assessor's Property Tax # (or attach legal descnphon) : Address l r;b.1:. <br />_ City r••,r ,.•i l State T > Zip <br />Servicing Electric Utility Phone ( ^na ) <br />Federal ID# or SSN <br />C. It Single Family, Zero Lot Line or D. If Multifamily (R-1) <br />Planned Unit Development Total # of Buildings <br />Total Conditioned Floor Area sq ft. Total # of Units <br />Second Duplex Unit sq. ft. Total sq. ft. (optional)__ <br />— — ---- HEAT SOURCE - - - ----- <br />A. Primary Space Heat Type <br />(check one) <br />❑ <br />Electric Baseboard <br />❑ <br />Electric Furnace <br />❑ <br />Electric Heat Pump <br />❑ <br />Other (specify bebw) <br />W.1- <br />1 Ic:1PC ri <br />COMPLIANCE <br />WSEC Compliance Method <br />n Prescriptive Path <br />r-1 Component Performance <br />1-1 System Analysis <br />B. Back -Up Space Heat Type <br />(optional, check off that apply) <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other (specify below) <br />C. Water Heat Type <br />(optional, check arm) <br />❑ Electric <br />❑ Gas <br />❑ Other (specify bebw) <br />INSPECTION/ENFORCEMENT <br />Date of Permit Application n. <br />Date Building Permit Issued _ <br />Date of Insulation Inspection <br />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 State 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 />of Building Official or Authorized Representative <br />Date <br />Return white copy to: Kelhleen Skeet, Washington State Energy Office, 809 Legion Way SE, FA_-11, Olympia, 98504.1211 <br />WSEO - while Copy UtilityiOw•ner - Canary Copy Junadictbn - Plnk Copy 6.g1 <br />