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WASHINGTON <br />STATE <br />CODE <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 />Attachrmitt B <br />WSEO Contract #_ <br />(please check one) <br />❑ Single Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development <br />Permit It _ <br />File ID #_(it different from Permt_ <br />�i CONSTRUCTION <br />A. Site Information B. Owner Information <br />Address Owner (mmw at lt'me of cnnetnrcdon romms ub'hlypoymany — <br />Cites_ — - Zip _ <br />Assessor's Property jax # (or affach Inal descriptions_ <br />Servicing Electric Utility _ <br />C. II Single Family, Zero Lot Line or <br />Planned Unit Development <br />Total Conditioned Floor Arne _ <br />Second Duplex Unit _ _ <br />A. Primary Space Heal Type <br />(cheek one) <br />❑ <br />Electric Baseboard <br />❑ <br />Electric Furnace <br />❑ <br />Electric Heat Pump <br />❑ <br />Other (spedfybelow) <br />COMPLIANCE <br />WSEC Compliance Method <br />❑ Prescriptive Path <br />❑ Component Performance <br />❑ System Analysis <br />Company_ __ <br />Address, <br />City __,.__._ State Zip <br />Phone ( ) <br />Federal IN or SSW <br />D. If Multifamily (R-1) <br />Total # of Buildings <br />sq, ft. Total Al of Units <br />sq ft Total sq. ft (optiona!) <br />HEATSOURCE <br />B. Back -Up Space Heat TypB <br />(optional, chock all that apply) <br />❑ <br />None <br />❑ <br />Wood <br />❑ <br />Electric Baseboard <br />❑ <br />Other (specify below) <br />C. Water Heat Type <br />(opflonal, check one) <br />Electric <br />❑ Gas <br />❑ Other (Specify below) <br />INSPECTION/ENFORCEMENT <br />Date of Permit Application _ <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 />Signature or Building Offidal or Authorized Representative <br />Return white copy to:_ Kathleen Skaar, Washington State Energy Office, 809 �q1on Way SE, FA-11. Olympia, WA 98504.1211 <br />WSEO - White Copy Utllityrowner - Canary Copy Jurisdiction -Pink Copy g.91 <br />