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Building Record <br />WSEO Cartirmt N <br />r.r <br />CLASSIFICATION _.....___ _.._..__.........___.._._.___ <br />(pleaF9 check one) <br />❑ New Building ❑ Addition over 500 sq.1:. <br />.IUriFdlCtlon: c,2" <br />pease check One: <br />��CitY ❑ Coun �— <br />A. Site Information — <br />Address // P Sf <br />City /tPl)2 ZIP <br />Assessor's Pro en Tax # o e n I al description) : <br />Servicing Elegrio Ulilit <br />C. If Single Family, Zero Lot Line or D. <br />planned Unit Development First <br />I! -CA.... N 1 SAG <br />A. <br />one pace Heat Type <br />(pchak <br />❑ <br />Electric Baseboard <br />yamry <br />. Electric Wall Heater <br />❑ <br />Electric Furnace ` <br />❑ <br />Electric Heat Pumn <br />❑ <br />Other <br />I <br />(pleas .check one) <br />Single Family ❑ Duplex <br />❑ Multilamily ❑ Zero Lot Line Home <br />B. Owner Info anon <br />Owner ow^or. 'me of con:DucfronrxeI utiliryp. <br />Compan <br />Address 4 <br />Cit Z� <br />e 0 s• <br />E. If Multifamily (R <br />=x t sq. fl. Total # of Buildin, <br />u e ni ft. Total # of Units <br />Heat Type <br />None <br />Wood <br />Electric Base t aard <br />Other (specify below) <br />C. Water Heat Type <br />(check one) <br />`❑'Electric <br />❑ Gas <br />❑ Other (specify below) <br />AN _. _ _ IN SPECTIONIENFORCEMENT <br />n ,) //�2' <br />Date of Permit Application <br />WSEC Compliance Metho This aiding meets the Date Building— r -� ry <br />❑ Prescriptive Path electric Date of Insulation Inspection <br />�Ccmponent Perto ante ❑ other fuels Date of Final Ins action <br />❑ System Analysi requirements of the WSEC. <br />artily that this building or addition has been inspecfed forthe meast. es required <br />i91 Washington State Energy Code (WSEC), that it Is In <br />substantial compliance <br />WSEC, and that the WSEC checklist for this building is on file. <br />1 hereby <br />by the 1 <br />with f(? <br />Signature of Be'.i irg Oltieial or Authorized Representative <br />Date <br />�r-- <br />Return canary copy to the servicing electric utility to (rigger WSEC compliance payrincrit <br />W <br />Return white copy to: Kathleen Skaar, Washin Ion State Ener 0lfice, P.O. Box 43166, Olympian WA - pink Copy <br />WSEO - white Capy utility/Owner - Canary COPY <br />