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D 1 <br />N <br />H H <br />� CA <br />9 <br />M oyz <br />O9� <br />Hag <br />t a <br />HH <br />y <br />HOta <br />i <br />Cj <br />I <br />U%ft <br />Building Record <br />(please check one) <br />❑ New Bullding ❑ Addition over 500 sq. it. <br />Jurisdiction' i— <br />please Mock one: 0 city ❑ County _ - <br />A. Site Information <br />CLASSIFICATION -_ <br />WSEO Contract N <br />Attachment B <br />(please Mock one) <br />❑ Single Family 0 Duplex <br />❑ Multifamily ❑ Zero Lot Line Home <br />_ ❑ Planned Unit Development <br />Permit# -- <br />File ID # (if different from Permit a) <br />CONSTRUCTION <br />Address j <br />�� -- City _zi <br />Assessor's Property Tax-Uora#ach aide ran: <br />!t > A <br />Servicin Electric Utility <br />B. Owner Information <br />Owner (owner at time of consfeJ00" 2Re V utiay peYmon9 _ <br />Company- <br />Audress <br />City _ State Zip <br />Phone _-A 1 <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 _ — sq. ft. _ Total It of Units <br />Second Duplex Unit sq. ft. Total sq. it. (optional) <br />HEAT SOURCE <br />A. <br />Primary Space Heat Type <br />(check one) <br />❑ <br />Electric Baseboard <br />❑ <br />Electric Furnace <br />❑ <br />Electric Heat Pump <br />❑ <br />Other (specify below) <br />B. Back -Up Space HeatTvpe <br />(optional, check all that apply) <br />❑ None <br />❑ Wood <br />❑ Electric Baseboard <br />❑ Other (specify below) <br />C. <br />Water Heat Type <br />(optional, check one) <br />❑ <br />Electric <br />❑ <br />Cas <br />❑ <br />Other tspe dy befowl <br />INSPECTION/ENFORCEMENT <br />WSEC compliance Method Date of Permit Application_ <br />❑Prescriptive Path Date Building Permit Issued <br />Date of Insulation Inspection <br />0 Component Performance Date of Final Inspection <br />❑ System Analysis <br />1 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 />Date <br />Signature of Building Official or Aulhonred nepresentalivo <br />Return white copy to: Kathleen Skeet, Washington State Energy Office, 809 Legion Way SE, FA 11, Olympia, WA 98504-1211 <br />WSEO -White Copy <br />utility Owner Canary Copy Junsdictlon - Pink Copy 6.91 <br />