2015, 07-02 Permit: BLD-2015-0759 Insulation CertificatePART 1 Residence Address
r
LOOSE -FILL
INSULATION CERTIFICATE
Date Installed
SpECIRLMED
§ffLAMULRT117N,Nc.
5O9,489,3512
S34 E. COZZA DRIVE
SPOKANE, WA SS208
CONT. L_Ic. # SPEC1119SS0
PART 2 Ceiling Areas Insulated (Loose Fill)
Square Feet
Existing
R -Value
Added R -Value
No. Bags
Lbs. Bag
Total Depth
Combined
R -Value
Insulation
Type
R -Value
R -Value
Type
1.
2.
3.
PART 3 ❑ Wall Area Insulated (loose Fill) ❑ Floor Areas Insulated
Square Feet
Existing
Added R -Value
No. Bags
Lbs. Bag
Total Depth
Combined
Insulation
R -Value
R -Value
Type
1.
2.
This certified that the above residence identified in Part 1 was insulated as specified in Part 2, or 3 and the installation was
conducted in conformance to applicable codes, standards and regulations at the time of installation.
(AUTHORIZED SIGNATURE)
WHITE COPY TO CUSTOMER •YELLOW COPY TO CONTRACTOR •HARD COPY TO ATTIC