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11
<br /> SNOHOMISH COUNTY Commercial&Industrial Energy Efficiency Services
<br /> iRI D INCENTIVE&TECHNICAL ASSISTANCE PROGRAM
<br /> PURIIC UTILITY DISTRICT NO. WORK AUTHORIZATION
<br /> Note: Due to limited conservation funds,this form must be signed and returned before August 15,2011
<br /> to be valid. The work Identified within this document must be completed and pass P.U.D.inspection on or before
<br /> November 15,2011 in order to be paid by the Agreement Expiration Date: December 15,2011
<br /> Facility Name Business 1 Building Owner Official Name(for payment)
<br /> Tax
<br /> � ID Number
<br /> ,h
<br /> Authorization
<br /> on Da
<br /> te
<br /> s1 Cyb �a$ 07/13/11
<br /> QaaYAFi-Lz kx
<br /> Facility Address Owner's Mailing Address(for payment) PUD Staff
<br /> h �' ° £ f +i �� t
<br /> 8 alr®0 � *�� t � '� o3 u P;9, Ken Satre
<br /> ..twa' <u
<br /> City State Zip City State Zip Project Number
<br /> Part0 ", P=3513
<br /> Xr • . •u� .3a XnNSer
<br /> x.� D �C-, .oc,"vc�,�..'"� x'�a* X�.,a,'x1 :1?'9•5'�,,,ei.rr.
<br /> ,�.�kvi�ea,.su.rr.e :9,.�.L•,ks�i.s'. .x,+pp.. «...g, ..,W.. � Kr.
<br /> WU
<br /> t„,� aw. ,+F . ' * 1�^ w" # 7y 5a �Y-i` Vo^ .;�S cwr, 4 * l
<br /> g
<br /> �sz
<br /> 4:V.7,*; t1wtve lectpe1
<br /> YN Pdo €Seccan ooSa
<br /> , b
<br /> 1 Z1zir 1` Z a ry Il 1 i j ait
<br /> ri 1 „ t jx $38,135.00 T $1,003.55 $5,758.82 28,794 kWh $2,029
<br /> ti
<br /> rJ ,441)4.,
<br /> rv,.
<br /> + ' r tiii'c'i!� f 1I'0)1'.4k10441:
<br /> 1 ,0� Aie11�1 >"�h �� �����jj,,������..�������yy,��,.,,,.�,��� n '� iw -
<br /> t ."7 P: aOsea}I f ♦ ' 1nEuni"J'n'-lAc�.'4iI I a a.�s' yW ro.
<br /> jtr !a 8ai �t1r, e a e Re. o�g,•. ce '�'1 �
<br /> .c, -- �• '"-' 2x..h 'Sia ��.��s �. ,g
<br /> Totals ' 35b 00>F t 5 8 8�`�{l,.�'s[ 7`4, "i` :..,$ 02
<br /> tArg
<br /> Incentive as a%of Project Cost► > ^ s� 4,t,
<br /> Savings as a%of Facility Total Annual Electrical Use
<br /> Measure&Verification(M&V)
<br /> .�.. �t, >•'t.• tx ° S .+a...z; •a.6.i1..,�0,. 1..4, 1,1 V. . �' . .1sem
<br /> •
<br /> ..5.
<br /> '
<br /> • tiE1t
<br /> allatlOn { Z' 011$,544 � tx '447411 . P r
<br /> 4!.61.., �aas.wa;M:,
<br /> I,the undersigned,understand the energy cost savings shown are estimates. These estimates are based on standard engineering calculations. I further
<br /> understand that I will not be eligible to receive payment until measures funded by the program have been installed an passed inspection by Public Utility
<br /> District No.1 of Snohomish County(the-PUD"). The actual incentive shall not exceed 70%of the authorized project cost for existing facilities. For new
<br /> construction project,the incentive shall not exceed 50%of authorized material cost or full Incremental cost. I understand that any changes in project
<br /> scope requires prior authorization before proceeding.
<br /> I agree to indemnify and hold harmless the PUD and each and all of Its agents or employees from and against any and all losses,liabilities,damages,
<br /> costs,expenses(Including reasonable attorneys'fees and expense),claims,judgments arising out of or in connection with participant in this program. I
<br /> understand it is the sole responsibility of the building owner or agent to obtain building andlor electrical permits,inspections and approvals
<br /> whenever they are required by law and to dispose of existing hazardous waste appropriately(see Lighting Waste Disposal Form).
<br /> I hereby certify that the information contained on this form Is,to the best of my knowledge,true and correct. I understand and will comply with the time
<br /> constrained listed.
<br /> Authorized Signature Date APPl'oVEDl
<br /> Print Name Title PUD Approval
<br /> Version lb-020111
<br /> 60
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