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k0 :o x <br />aHf~n <br />K c~i <br />H <br />ox0 <br />� NH <br />OH <br />HM8 <br />Q. 0 <br />C" H <br />yH <br />H <br />A t7 V1 <br />[Cr•7 r <br />m <br />H O CA <br />�-j <br />WASHINGM, I <br />AttaCltmetd B <br />may Building Record WS DCoBtrwit <br />MRAM <br />CLASSIFICATION _ <br />(please check one) (please check one) <br />DNaW Building ❑ Addition over 500 sq. ft. ❑ Single Family ❑ Duplex <br />Jurisdiction: ❑ Multifamfly ❑ Zero Lot Line Home <br />_ _ ❑ Planned Unit Developmi nt <br />❑ <br />ukase d eck one: ❑ Clty .County Permit # <br />File ID # (if different from Permit - <br />CONSTRUCTION _ <br />A. Site Information <br />Address i' ) <br />City I Zip <br />Assessor's Property Tax # (or attach legal description) <br />Servicing Electric Utility <br />C. If Single Family, Zero Lot Line or <br />Panned Unit Development <br />Total Conditioned Floor Area <br />Second Duplex Unit <br />A. <br />Primary Space Heat Type <br />(cheek ons) <br />❑ <br />Electric Baseboard <br />❑ <br />Electric Furnace <br />❑ <br />Electric Heat Pump <br />❑ <br />Other opeafy bebwl <br />COMPLIANCE <br />WSEC Compliance Method <br />❑ Prescriptive Path <br />❑ Component Performance <br />❑ System Analysis <br />B. Owner Information <br />Owner townev ar rime of awisb ctb retches eay �aYme U __ <br />Company - <br />Address <br />City State <br />Phone <br />Federal ID# or SSN <br />D. II Multifamily (R-1) <br />Total # of Buildings <br />sq. it. Total # of Units <br />- <br />sq it Total sq. ft. (optional) <br />_. <br />HEATSOURCE <br />B. <br />Beck -Up Space Heat Type <br />C. <br />Water Heel Type <br />(optional, check all that apply <br />(optional, check one) <br />❑ <br />None <br />❑ <br />Electric <br />(-1 <br />Wood <br />❑ <br />Gas <br />❑ <br />Electric Baseboard <br />❑ <br />Other (specify below) <br />❑ Other (specify bolowl _ <br />INSPECTIONANFORCEMENT <br />Dale of Permit Application _ <br />Date Bwldi OPermil Issued <br />Date of Insulation Inspection <br />Date of First 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 Wf,EC, and that the WSEC checklist for this building Is on file. <br />Signature of Bui.uing Olhoal nr Aulhodred Representative <br />Return while copy to: Kathleen Skaar, Washington State Energy Office, 809 Leglon Way SE, FA 11. Olympia, WA 98504-1211 <br />WSI 0 lNhate Copy Ura ty'Owrier CanaryCopy Jurisdiction • Pink Copy 6.91 <br />I <br />n <br />