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0 <br /> PSE PUGET SOUND ENERGY <br /> GAS SERVICE APPLICATION <br /> NON-RESIDENTIAL PERMANENT 201G <br /> For buildings,all or a portion of which is intended for commercial,retail,or general public activities.This includes community wells <br /> (backup generator),barns and garage shops/outbuildings.Use for new construction or existing structures converting to natural gas from <br /> an alternative fuel,e.g,oil,propane,or electricity.Please submit the CSIS form in addition to this application.For new construction,a site <br /> plan or sketch(Box A)must be submitted in orderto be processed.If existing construction,please sketch the building footprint in Box A. <br /> I NEED GAS SERVICE FOR: 0 NEW CONSTRUCTION on ❑✓ EXISTING CONSTRUCTION <br /> CUSTOMER INFORMATION <br /> PROJECT NAME PARCEL i LOT NO. <br /> Eight Ball Cafe 625 D-00115 <br /> PROJECT ADDRESS <br /> 2727 Colby Ave,Everett 98201 <br /> CONTRACTOR CONTACT NAME <br /> Rachid Ayouni Rachid Ayouni <br /> PHONE 1 I PHONE 2 FAX NO. E-MAIL <br /> (206)8414070 rachid.ayotml@gmail.com <br /> INSIDE CITY OMITS? CONSTRUCTION START DATE DESIRED SERVICE DATE <br /> Q YES 0 NO 10/11/2017 11/01/2017 <br /> SERVICE INFORMATION <br /> NO.OF BUILDINGS(FOR EACH BUILDING SUBMITA SEPARATE 201G FORM) SERVICE ADDRESS FOR BUILDING <br /> 1 2727 Colby Ave,Everett 98201 <br /> SUITE ADDRESSES FOR THIS BUILDING <br /> 2727 Colby Ave,Everett 98201 <br /> TYPE OF BUSINESS I so.FOOTAGE NO.OF METERS <br /> Restaurant 2400 l 1 <br /> DELIVERY PRESSURE DESIRED ■ 6"WATER COLUMN Q 2 PSI M OTHER PLEASE SPECIFY) <br /> LOAD INFORMATION <br /> GAS EQUIPMENT NO OF UNITS BTU I UNIT TOTAL BTUs 1 HR <br /> Pizza oven 1 200.000 200,000 <br /> Griddle 2 100,000 200,000 <br /> Char Broiler 1 100,000 100,000 <br /> Deep Fryrer 2 90.000 180,000 <br /> Convection 2 80,000 160,000 <br /> TOTALS 8 570,000 860,000 <br /> MOVING EXISTING FACILITIES INFORMATION <br /> WILL EXISTING GAS FACILITIES REQUIRE RELOCATION? PLEASE DESCRIBE <br /> ❑ YES ❑✓ NO(MARK ON SITE PLAN) <br /> SPECIAL INSTRUCTIONS BOX A—PLEASE SKETCH BUILDING FOOTPRINT.METER AND TRENCH LOCATION <br /> Meter in back alley.Existing meter is not sufficient for new conceprs need. '...:_..-._ n 1 <br /> ( <br /> IN <br /> 0 3 ism <br /> cST1r,q <br /> I understand this plication is a preliminary step to get information about natural gas service and that it is not an agreement to use gas <br /> or have gas instal .. f decide to have gas installed,a Gas Agreement will be sent for'signature and that agreement will be the official <br /> notice to proceed is installation. <br /> VAC <br /> PRINT AUTHORIZED E ,y,A• AUji�(7_ J t�C{J'`t DATE f 0 11 ( �'7 <br /> 01 0"` 1 <br /> Please mail signe and completed form to the selected office. <br /> MAILING OPTIONS: O Puget Sound Energy(CCS) E-mail signed and scanned form to: <br /> 3130 S.38th St. NewServiceADDlications@PSE.com <br /> Tacoma,WA 98409 <br /> Fax:253.476.6007 <br /> or 253.476.6421 <br /> OFFICE USE ONLY <br /> UMAP NO./PLAT NO. CLXCUST NO. CLX STMT NO. - CLX SUB NO. SAP NOTIFICATION NO. <br /> ----,13) <br /> j <br /> 3504 04112 PAGE 1 OF 1 f 3 <br />