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ME <br />C H <br />aHrn <br />y 3 <br />�C n <br />H0 <br />"mod H 'd <br />IA H <br />o5 <br />13 0Hd <br />a�0 <br />aV (�] <br />yH <br />yzH <br />rHH <br />H O rrAi, <br />N <br />�J <br />Attachment B <br />Building Record wsEO« <br />CLASSIFICATION <br />(please check one) <br />❑ New Building ❑ Addition over 500 sq. ft. <br />Jurisdiction: <br />please check one ❑City ❑ County _ _ <br />A. Site Information <br />Address <br />City --- -: -- Zip <br />Assessor's Properly 1 ax # (or allach legal drscnphonl <br />Servicin Electric k lifiry __-_ - <br />C. If Single Family, Zero Lot Line or <br />Planned Unit Development <br />Total Conditioned Floor Area <br />Second Duplex Unit <br />Q� <br />_, <br />A. <br />Primary Space Heat Type <br />(check one) <br />�Mile <br />❑ <br />Electric Baseboard <br />❑ <br />Electric Furnace <br />On❑ <br />Electric Heat Pump <br />❑ <br />Other (specify bekav) <br />'~ �• COMPLIANCE <br />IMI� WSEC Compliance Method <br />❑ Prescriptive Path <br />•� ❑ Component Performance <br />❑ System Analysis <br />(please Cheri( one) <br />❑ Single Family ❑ Duplex <br />[]Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit # <br />File ID # {ri di#erem from Permtt�l __ <br />B. Owner Information <br />oconhctin recees #qpermeMl—Owner (wnerattimor u <br />Company -- — <br />Address --- -- <br />City State Zip -- <br />Phone ( ) -- <br />Federal ID# or SSN <br />D. If Multifamily (R-1) <br />Total # of Buildings <br />sq. ft. Total # of Units <br />sq. ft. Total sq. it. (optional) <br />NEAT SOURCE -__. <br />B. Back -Up Space Heat Trpe <br />C. <br />Water Heat Type <br />(optional, check one) <br />(optional, check all that App y <br />() None <br />❑ <br />Electric <br />n Wood <br />❑ <br />Gas <br />[_1 Electric Baseboard <br />❑ <br />Other (specify bebw) <br />❑ Other (specify below) <br />— <br />INSPECTIONIENFORCEMENT _ <br />Date of Permit Application <br />Date B6ilding Permit Issued <br />Date of Insulation Inspection <br />Date of Final Inspection <br />1 hereby certify that this building or addition has been inspected for the measures requi <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 />Signature of Building Official a Authorized Representative <br />n,m• <br />Return white copy to: Kathleen Skaar, Washington State Energy Office, 809 LEgion Way SE. FA-1 1. Olympia,W A Copy 1 11 <br />WSEO - White Copy utiliryiOw'ner - Canary Copy <br />