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YVASHING70N <br />CODE Building Record WSEO Contract # Attachment B <br />WRAM <br />CLASSIFICATION <br />(please check ono) <br />XNew Building ❑ Addition over 500 sq. N. <br />Jurisdiction: DD7 - 4Z&AM,4 <br />please check one: [X City ❑ County <br />A. Site Information <br />Address ILd3 <br />City ZiP % SD3 <br />Assessor's Pro eft Tax # or attach le al descn Lion <br />Servicing Electric Utility <br />C. If Single Family, Zero Lot Line or D. Duplex <br />Planned Unit Development II First Du <br />A. Primary Space Heat Type <br />(check one) <br />❑ <br />Electric Baseboard <br />Electric Wall Heater <br />❑ <br />Electric Furnace <br />❑ <br />Electric Heat Pump <br />❑ <br />Other <br />(please check one) <br />Single Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot line Home <br />❑ Planned Unit Development <br />Permit # A //.a- / <br />File ID # (it different from Permit A5 <br />B. Owner Information <br />Owner (ownerat Bmeolconshxdonrweimsutilitypaymerx) <br />Company W,Y�,—, (7/LS <br />Address C;R/&//�Zyll< CE <br />city /6_ � // State f1 Zi 9 vim/ <br />Phone (aDCn ) /_ - _9 <br />E. If Multifamily <br />Unit sq. ft. Total # of Built <br />B. Secondary Space Heat Type <br />(check all that apply) <br />1 None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other(specily below) <br />COMPUANCE _ <br />WSEC Compliance Method <br />Prescriptive Path <br />❑ Component Performance <br />❑ System Analysis <br />This building meets the <br />A electric <br />❑ other fuels <br />requirements of the WSEC <br />C. Water Heal Type <br />(check one) <br />Electric <br />❑ Gas <br />❑ Other (specify below) <br />INSPECTIONANFORCEMENT <br />Date of Permit Application ,r,// y- V_ <br />Date Building Permit Issued tS9 S/ <br />Date of Insulation Inspection _ 6-2 _ <br />Date of Final Inspection 7--` — <br />I hereby certify that this building or addition has been Inspected for the measures required <br />by the 1991 Washington State Energy Cocle (WSEC), that it is In substantial compliance <br />wit the WSEC, and that the WSEC checklist for this building is on file. <br />Sig ure wldng Official or Authorized Representative Date <br />Return canary copy to the servicing electric utility to trigger WSEC compliance paymen! <br />Return white copy to: Kathleen Skean Washington State Energy Office, P.O. Box 43165, Olympia, WA 98504.3165 F 12 et <br />WSEO - White Copy Utility/Owner - Canary Copy Jurisdiction - Pink Copy <br />