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WASHINGTON <br />STATE <br />E ERGY <br />COD <br />PROGRAM <br />Building Record <br />(pieao check one) <br />chew Building , T Addition over 500 sq. it. <br />Jurisdiction: <br />please check one: ll(( City ❑ Cr-�jnty <br />Atfaclfinal, B <br />Ma cmftct #_ <br />CLASSIFICATION <br />�( l,ea�se check one) <br />dingle Family ❑ Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />❑ Planned Unit Development__ <br />Permit # <br />File ID # (a different from Permit M <br />A. Site Information B. Owner Information <br />Address L3% ' Owner(owrKverrrmeorconsoucrronrecorresuonnparma�_ <br />L;iiv Zip Comnanv olt- /Ad) ; <br />L%i /-S ' <br />Asses or'sPro artyTax If orattach l al de n: Address , -�/h <br />_ tiiz <br />, <br />City - .l `r�3,'' 0. State ZI i <br />2 <br />ServicingElectric Utili (/[� Phone <br />Federal ID# or SSN <br />C. if Single Family, Zero Lot Line or D. If Multifamily (R-1) <br />Planned Unit Development Total # of Buildings <br />Total Conditioned Floor Area �/12 s Total If of Units__ _ <br />Second Duplex Unit _ --sq._fL- Total sq. ft. (optional) <br />�HEAT,SOM.— <br />A. Primary Space Heat Type <br />(check one) <br />❑ ectric Baseboard <br />(ectric <br />Wall Heater <br />❑ <br />Electric Furnace <br />❑ <br />Electric Heat Pump <br />❑ <br />Other <br />B. Back -Up Space Heat Type <br />(check oil that apply) - <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other (spedlybelow) <br />C. Water Heat Type <br />(check one) <br />Cl clectric <br />❑ Gas <br />❑ Other (specify below) <br />.. 'b 'OOINPLTANCE' r" INSPECTIONIENF.ORCEIWE <br />This building meets the WS`_C Compliance Method Date of Permit Application <br />❑ Electric ❑" Presciiplive Path Date Building Permit Issuedj['i <br />❑ Other Fuels ❑ Component Performance Date of Insulation Inspection (-7L7-2S <br />requirements of the WSEC. ❑ System Analysis Date of Final Inspection <br />I hereby certify that this building or addition has been Inspected for the measure: required <br />py the 1991 Washington State Energy Code (WSEC), that It is In substantial compllanre <br />w th the PSEC, and at the WSEC checklist for this building Is on Via. <br />I Si u e c f Building Official or Authodzed Represenlative Date 1 <br />Return white copy to Kathleen Skaar Washington State Energy Office, 809 Legion Way SE FA-11, Olympia, WA 98504.1211 <br />WSEO •White Copy utintylowner - Canary Copy Jurisdiction - Pink Copy <br />7.02 <br />