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N <br />CHINGTON <br />Building Record Attachmeltt B <br />�SE� Comtracf # <br />Wr <br />�oG�n <br />_- _CLA0FICATIQN___ _ <br />laese checf. one) please check one) <br />(New Building ❑ Addition over 500 sq. ft. Single Family ❑ Duplex <br />Jurisdiction: i1 h , D t f rl , r ❑ Multifamily ❑ Zero Lot Line Home <br />_ ❑ Planned Unit Development <br />please check one: City ❑ County Permit # 'j, y' :. - "-) <br />File ID # (uddferanthom permRal <br />A. Site Information B. Owner Information <br />Address / ? f _ Owner lownerar eYr a aconsmnabn lacer es uram pay,, e„u <br />City zip 'Y <br />Assessor's Property Tax # rorahachfeoafdescdprwn): <br />Servicing Electric Utility `rrrn ,) '0 /�✓ / <br />Company ✓./ <br />Address 9/n// !; j -7 ) <br />City /' i'&Y• , ; /e Statetr/'-) zip <br />Phone ( .'cCn ) `,• -9 - y-� �� <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 (a4(ot) sg ft Total # of Units <br />.Second Duplex Unit ___sq. ft. Total sq. It. (optional) <br />----- <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 />B. Back -Up Space Heat Type <br />(check all that apply) <br />Q None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other (specify below) <br />C. Water Heat Type <br />(check one) <br />Electric <br />❑ Gas <br />❑ Other (specify below) <br />_- C"MiNCE -- _ WVPTIOMLENFOR_CEjW <br />This building meets the _WSEC Compliance Method Date of Permit Application <br />Electric ❑ Prescriptive P.,tlI Date Building Permit Issued •• r - <br />Other Fuels Component Performance Date of Insulation Inspection -_ <br />requirements of the WSEC. ❑ System Analysis Date of Final Inspection - - �/ -J <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 /t /s In substantial compllanre <br />with the WSEC, and that the WSEC checklist for this building Is on file. <br />Su-L='-sue—.� __�-.• <br />ture of Building Official or Authorized Representative D to ! <br />Return whlts oopy to: Kathleen <br />WSEO - While Copy <br />Washington State Energy Office, 809 Legion Way SE, FA-11. Olympia, WA 98504.1211 <br />thilityrownsr - Canary Copy Judsdedfon • Pink Copy <br />1.92 <br />