1730 BAKER AVE 2019-03-21 - Laserfiche WebLink

JAN-25-2019 15:38 From:Arlington—Electric 360+435+6970 To:4252578857 Page:6/11 PUD 135E ONLY Ili,, INTERCONNECTION PPIll j Ira LICA T Z FILE NUMBER PUMA!:UTILITY DI:.TRICT NC I. 1 FOR SNOHOMISH COUNTY PUD CUSTOMERS ONLY 2312 09/17 • T — CUSTOMER INFORMATION(PLEASE PRINT) _ APPLICANT NAME ACCOUNT NUMBER Emily Wicks _ (2.U5Sbq L5 MAILING ADDRESS CITY STATE ZIP CODE 1730 Baker Street Everett WA 98203 — DATE PHONE EMAIL ADDRESS / 1/18/2019 425-876-6554 t .1.0 i elcS EQ cl -`.L. r co m INSTALLATION INFORMATION(PLEASE PRINT) INSTALLATION ADDRESS CITY STATE ZIP CODE -Inc)Baker Street Everett WA 98201 EMERGENCY CONTACT NAME PHONE ENERGY SOURCE(E.G.,WIND,SOLAR,HYDRO,ETC.) Emily Wicks 425-876-6554 SOLAR RATED FACILITY OUTPUT(INDICATE KVA OR kW) NUMBER OF PHASES VOLTAGE OUTPUT 12KW single 240 GENERATOR MANUFACTURER MODEL NUMBER Sitfab Silfab 300 INVERTER MANUFACTURER(D.C.SYSTEMS ONLY) MODEL NUMBER VOLTAGE OUTPUT BlueFrog YC500A 240 SOLAR INSTALLER(BUSINESS NAME) Arlington Electric REMEMBER TO: 1J Attach a copy of the generator manufacturer's specification sheet. O Attach a copy of the inverter manufacturer's specification sheet(if applicable). ❑Attach a Facility and Proposed Interconnection Wiring Diagram(include all circuit breakers,fusing and protective devices). LI Provide an elevation(side view)drawing showing the proposed relative location of the generation meter compared to the cus- tomer"net'or utility meter. The meter base for the production meter must be located as required in the PUD Electrical Service Requirements. O Sign and date your application and Agreement. O Retain a copy of the application and Agreement for your records. O Production Incentive inspection and meter installation fee,payable at all ND office locations. I acknowledge receipt of Snohomish County PUD's Net Metering Agreement and Rate Schedule 200.I have read and understand the contents of these documents and I agree to fully comply with and be bound by all of the terms and conditions contained therein.This is to further certify that I understand this application is not an authorization to interconnect. I understand that my interconnection equipment and wiring will have to be inspected and approved by the Snohomish County PUD prior to any interconnection with the utility's facilities. By checking this box,inserting my name on the signature line below,and submitting the form electronically to the PUD,I 15?! certify under penalty of perjury under the laws of Washington state that the information provided above Is true and correct. Email to:solarexpress@snopud.com. CUSTOMER SIGN• DATE 40 4111, 1 i 13 I U k . 1 Please r• rn this •mplet d,s'.ned application with appropriate manufacturer specifications sheets to: Ene = Efficiency Services,Snohomish County PUD,PO Box 1107,Everett WA 98206-1107 ENERGY HOTLINE:425.7834700,Monday-Friday,8 AM to 5 PM(toll-flee in Western Washington and outside the local Everett calling area at 1-877-783.1000)