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EUC Forms.pdfA coordinated utility etiviroiimerrit which oiaxiiiiizesjobit utility opportunities to provide quality, service for the citizens oJ'Edmonds YOU WILL BE GIVEN A CONFIRMATION NUMBER BY L4CHUTILITY ONCE YOU HAVE INFORMED THEM OF YOUR PROJECT. SITEADDRESS: damanzwommm NUMMMMMEMMSIM f V -P -- co Mary McAllister - 425.670-3216 You will need to provide PUD with a site plan and a completed New Service Questionnaire. P U G E, I' E EIVED SOUND # APR 7 ENERGY i')fiV New Customer Construction Call to verify gas availability and to coordinate service install. 61u'wft need to Department - 1.888-.321.7779 provide parcel number, contact phone number and trailing address. 'fi-ol ,ii-hei Q. Aralmrne to the New Frontier You will need to provide Frontier with the location of your project, total line Jeremy Fallt - 425-263-4024 requirement, and the date in which service is required. A copy of your You will need to provide Comcast with the location of your project, a copy of Mike Fontenot 425,263,5482 your development and site plan (digital copy if available.) The date in which service is required and a list of contact names, phone numbers & mailing Steve Dunphy - 425.774-7769 ext. 110 You will need to provide OVWSD with the survey map of your site and For customers in Olympic Victiv Service Area complete a development information form. 1#11110101=35,01611 SERVICES STAFF AT' THE TIME OF PERMIT SUBMITTAL Rev. 10/1/1> mills, "�'gagw" 1:426119114011 . will 4 A' 11 For new construction development of two (2) or more single family residential adjoining parcels. Please submit the CSIS form in addition to this a plication. A site Ian must be submitted with the form in order to be rocessed. o e o PROJECTNAME •'/ Jrry''Nck SA "A x 11 "v /'y, DNISION PROJECTADDRESS ,' l ..-- `' A' �� l c�(.. J C &gk�j8.1W1c CONTRACTOR „,.�� r„ CPNTACT,7, E eT/ q PHONE 1 =NEI FAX NO. lTAIL INSIDE CITY LIMITS? CONSTRUCTION START DATE DESIRED SERVICE DATE El YES ❑ NO - - - ,_. • o PROPOSED BUILD-OUTSCHEDULE PROPOSED DATECLEARING ISSCHEDULED ''- 6 (I'YEAR COMMENCES WHEN GASMAN IS PUT w -"'CE 1`YEAR PROPOSED DATE WET UTILITIES ARE SCHEDULED i a p ND PROPOSED DATE CURBS AND PANNG ARE SCHEE 2" YEAR CJr A 3ftl YEAR4� PROPOSED DATE SERVICE DESIRED _. AVERAGE SQUARE FOOTAGE OF HOME" YEAR 5'" YEAR O IS THIS ZERO LOT LINE CONSTRUCTION? ❑ YES NO TOTAL NUMBER OF HOMES I NONE= Gas usage /appliances to be installed per home/ unit. Please indicate the proposed Natural APPLIANCE BTUs APPLIANCE BTUs APPLIANCE BTUs HEATING CLOTHES DRY ER ❑ FIREPLACE (HEAT RATED)' WATER HEATING ❑ HOT TUB FIREPLACE (DECORATIVE) ❑ WATER HEATING -ON DEMAND ❑ POOL ❑ GENERATOR uLs3 COOKING ❑ OTHER -PLEASE IDENTIFY RELOCATION OR REMOVAL OF EXISTING GAS FACILITIES NEEDED? ❑ YES jNO PLEASE DESCIWBE DOES PROJECT INCLUDE FRONTAGE IMPROVEMENT? ❑ YES NO PLEASE DESCRIBE SPECIAL INSTRUCTIONS I understand this application is a preliminary step to get information about natural gas service and that it is not an agreement to use gas or have gas installed. If I decide to have gas installed, a Gas ?eveloper Agreement will be sent for signature and that agreement will be Please mail signed and completed form to the selected office. MAILING OPTIONS: 0 Puget Sound Energy (CCS) E-mail signed and scanned form to: 3130 S. 38th St. N01,v°Sr=e v^,;ah\lq)lu'vrtioi) (rel of Gxam Tacoma, WA 98409 Fax 253 476.6007 or 253.476.6421 OFFICE USE ONLY UMAP 1,167W T- .CLX CUST NO. CLX STMTNO. CLX SUB NO. SAPNOTIFICATIONNO, 4400 DWI PAGE i OF I FPSE ' • 1 CHARGES FOR CONSTRUCTION AND ENERGY USAGE WILL BE BILLED TO THE PROJECT OWNER THIS FORM MUST BE SUBMITTED ALONG WITH THE APPROPRIATE APPLICATION(S). e 01 v. DATE PROJECT OWNER* ` BUSINESS TAX ID (IF APPLICABLE) MAILING ADDRESS CITY t -*Ate L nna�.� STATE ZIP PHONE 1 e-ry PHONE 2 E- IL 1Q'ru- ((-6tt S—V-A lAQ� 1,..j� PROJECT NAME (IF APPLICABLE) PROJCT SITIP 4E o \ ADDRESS `�1'\ c CITY �Y�� v� Z PROJECT COORDINATOR (CONTACT) v PHONE - a _ au vc E-MAIL c.c t e r (Q.,' u{ 6A- - NON-RESIDENTIAL ------------------------------------------------------------------- PLEASE CHECK ALL THAT APPLY AND ATTACH THE CORRESPONDING FORM FOR EACH SERVICE FOR A LIST OF DEFINITIONS AND CORRESPONDING FORMS, PLEASE SEE PAGE 2 TO SUBMIT: EMAIL - ATTACH FILE OR SCAN COMPLETED SIGNED FORM(S) TO NEWSERVICEAPPLICATIONS@PSE.COM MAIL - COMPLETED SIGNED FORM(S) TO THE OFFICE BELOW: PUGET SOUND ENERGY (CCS) 3130 S. 38TH ST. TACOMA, WA 98409 FAX: 253-476-6007 or 253-476-6421 sm �4WOR�� .� ��a RESIDENTIAL ------------------------------------------------------------------- 100E ---------------------------------------------------------------- ❑ ---------------------------------------------------------------- 100G NON-RESIDENTIAL ------------------------------------------------------------------- ---------------------------------------------------------------- ---------------------------------------------------------------- TEMPORARY 200E ---------------------------------------------------------------- ❑ ---------------------------------------------------------------- ------------------------------------------------------------------- PERMANENT 201E ------------------------- --------------------------------------- ❑201G ---------------------------------------------------------------- El ------------- RESIDENTIAL PLAT DEVELOPMENT -------------------------------------------------- 300E ------------------------------------------- ❑ 30OG ❑ ------------------------ -------- --------- MULTI -FAMILY DEVELOPMENT 400E ❑ 40OG El TO SUBMIT: EMAIL - ATTACH FILE OR SCAN COMPLETED SIGNED FORM(S) TO NEWSERVICEAPPLICATIONS@PSE.COM MAIL - COMPLETED SIGNED FORM(S) TO THE OFFICE BELOW: PUGET SOUND ENERGY (CCS) 3130 S. 38TH ST. TACOMA, WA 98409 FAX: 253-476-6007 or 253-476-6421