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07120/2016 11;05 (FAX) P.0011001 <br /> 10 <br /> COMMERCIAL <br /> NEW SERVICE QUESTIONNAIRE I AGREEMENT-S NOHVO SH CO NTY PUD <br /> ,007r REY.o /�, Ibv2S4W(1- . <br /> CUSTOMER'S NAME POEUS)Do (zo\j 1 & CbM,M.dnei AL EMAIL M I SSa01h142 PLC0,16e.Ca <br /> Ir (LEGAL NAME FOR CONTRA ) <br /> —PHONE:WORK(W\S) 332-nQW(( _0ME( ) _ CELL( ) FAX( ) <br /> SERVICE ADDRESS qr!p pd)"` k\/C-: 6v L_MomW <br /> NW <br /> MAILING ADDRESS <br /> 3001y ANe 1�.q S ECO/UQ CLW_ SA�U. /4G,tM, L1 <br /> IhlU J804 AND eTRa7 ADORM CrTy.SWE ZIP COflB ? /,,I / <br /> ARCHITECT/SURVEYOR NIS WA OLSO N (PM KA NN-V� WORK PHONE (5� ).l z9- LI E['�1 <br /> ELECTRICAL ENGINEER OR CONNTS -TOROut.I'� AT �GT21 L EMAIL 1-RIS aN <br /> FHUNt- WUMK(T_0fo ) 9'7f-,?(?b4 FAX(amu L ) ^� SO CCLL(!- � I1?1, 1'� S�,r <br /> PROJECT COORDINATOR R t O �� _ �NJ EMAIL LSI /)Oir,,Cf ) <br /> PHONE: WORK LS - 3--AX S 33Z-83Q CELL t5 855. <br /> It Job Is not yet bid out,what Is the expected bid date? Approximate date aervics will be required: <br /> GRADES 8 STAKES FORM SIGNED?: O YES d NO <br /> TYPE OF FINANCING: ❑CASH D LETTER OF GUARANTEE O PERFORMANCE BOND <br /> N ORDER TO PROCEED WITH THE ENGINEERING AND UL IIERMINATION OF CHARGES,THE FOLLOWING INFORMATION MAY BE REQUIR <br /> t. Snohomish County or appropriate governmental agency Critical Area Regulation or other requirements have been met and <br /> details attached? Oyes O No (If"N0,"Information must be provided to the PUD before proceeding with englneering) <br /> 2. Throe complete copies of the sites plan(including water.Bower and storm)-one electronic file preferred <br /> 3. Legal description(Include copy of deed) <br /> 4. Complete riser diagram <br /> 5. Desired metering location(one location per bullding)and Desired Transformer Location <br /> 6. WIII existing power facilities require relocation? 0 Yes 0 No (d'yes,"mark on site plan) <br /> REQUIRED ELECTRICAL INFORMATION <br /> ELECTRICAL SERVICE ENTRANCE SIZE: Q 200 AMP Q 400 AMP 0 AMP <br /> OVERHEAD Q UNDERGROUND MV0LTAGE 12-0 / 2.4_0 *INGLE•PHASE Q THREE-PHASE <br /> SERVICE ENTRANCE: TOTAL NUMBER OF CONDUCTOR RUNS: 3 <br /> PHASE WIRE SIZE -9 ( A L NEUTRAL WIRE SIZE 14-L- <br /> TYPE OF HEAT: O ELECTRIC O GAS 7 WOOD O OTHER(SPECIFY) <br /> TYPE OF COOLING: U ELECTRIC U GAS J NONE U OTHER(SPECIFY) <br /> TYPE OF BUSINESS. BUSINESS S0. FOOTAGE: <br /> WILL THERE BE ANY GENERATION AT THIS FACILITY? J YES � <br /> IF"YES," WHAT KIND OF INTERCONNECTION DO YOU INTEND ON USING? ON <br /> N TIRANSITION O CLOSE TRANSITION <br /> TOTAL ELECTRICAL LOAD: ��+� P Co�✓S�i�-u `Ti ID�.� o b 2A (-tom ©'v j >� �� <br /> EXISTINO NEW VOLTAGE PHA$ <br /> LIGHTING KW KW <br /> HEATING KW KW <br /> AIR CONDITIONING KW KW <br /> WATER HEATING KW KW <br /> MOTORS KW KW (PLEASE DESCRIBE DETAILS aELOM <br /> MISCELLANEOUS KW KW <br /> TOTAL: KW KW <br /> MOTORS'(CHARACTERISTICS OF PROPOSED LOAD): <br /> 812E IN HP OUANTITV SOFT START? STARTING RUNNING PHASE CLASS VOLTAGE N0.OF PER <br /> Yes OR NO AMPS AMPS STAWs DAY OR HOUR <br /> 'PLFASE ATTACH ADDITIONAL SHEET WITN IDENTICAL CATEOOAY L(S77NOS IF YOU NEED MORE ROOM, <br /> It Is understood that h additional work Is required of the PUD,due to customer revisions of the electrical load and/or voltage require- <br /> ments or other Information as supplied or requested on this form,the additional costs shall be borne by the customer.The PUD pro. <br /> vides for Inatelled load, not future load. ,�— <br /> CUSTOMER SIGNATURE DATE; '21'7..t1(0 <br />