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CUSTOMER - EUC
CONTACT
Form
A coordinated utility environment which maximizes joint utility opportunities to provide quality service for the citizens of Edmonds
YOU WILL BE GIVEN A CONFIRMATION NUMBER BY EACHUTILITY ONCE
YOU HAVE INFORMED THEM OF YOUR PROJECT.
SITE ADDRESS: ZOOz� '6S ; `� A vE W
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Mary McAllister - 425-670-3216
You will need to provide PUD with a site plan and a completed New Service
Questionnaire.
PUGET
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SOUND
ENERGY
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V New Customer Construction
Call to verify gas availability and to coordinate service install. You will need to
Department - 1-888.321.7779
provide parcel number, contact phone number and mailing address.
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Now Frontier
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You will need to provide Frontier with the location of your project, total line
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requirement, and the date in which service is required. A copy of your
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Mike Fontenot 425-'2'6�,5482
You will need to provide Comcast with the location of your project, a copy of
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
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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 View Service Area
complete a development information form.
THIS FORM MUST BE COMPLETED AND GIVEN TO DEVELOPMENT
SERVICES STAFF AT THE TIME OF PERMIT SUBMITTAL Rev. 10/1/13
PUGET SOUND ENERGY
Puget Sound Energy
P.O. Box 97034
Bellevue, WA 98009-9734
PSE.com
May 41h 2018
Eric
Eric Haines, EIT
9740 Evergreen Way
Everett, WA 98204
425-356-2700 x107
website: wesi.co
To Whom It May Concern,
Puget Sound Energy (PSE) will provide new gas service to 20020 83rd Ave
W, Edmonds, Wa 98026, TaxAcct No. 00431200000201 according to the
terms and conditions of Rule 6 and with the Washington Utilities and
Transportation Commission.
Any Easements needed to serve the parcel or special permits or conditions
required by those permits are the sole responsibility of the owner in
accordance with the same schedule and tariff listed above.
Thank You,
Jordan Cooper
Associate Project Manager / Customer and System Projects
® PUGETSOUND ENERGY
Cell: 425-623-5302
Jordan. Cooper@ pse.com
PLEASE EMAIL REQUESTS
PUG ET Maps & Records
SOUND External Request Form Phone (425) 456-2511
ENERGY email: MapRequest@pse.com for
forms and returning completed forms
355 110th Avenue NE, Bellevue WA 98004
Please allow 5 to 10 working days for delivery.
Date 4/4/2018
Phone 425-356-2700 107
EXT.
Agree to PSE' Security Agreement I YES I yes
Utility Information Requested: Electric x Gas
Contact Name Eric Haines
Contact email: erich@wesi.co
Agency/Firm Western Engineers & Surveyors, Inc.
Address / Street 9740 Evergreen Way
City, State, Zip Everett, WA 98204
Project Type:
Public Improvement (Road Widening, Sidewalks, Utilities, Etc.) City, County, Township (Funded)
x Private Development (New Construction, Residential, Commercial, Industrial, Short Plats, Etc.)
Project Name: Evans Short Plat
Project Location I Site Address: Please include cross street before and after requested address:
20020 83rd AveW, Edmonds. WA 98026
Approximately 150 feet south of the intersection of 200 Street SW and 83rd Avenue W
Required: Project COUNTY - City & Zip Isnohomish JEdmonds 98026�
County City Zip
REQUIRED* 1/4 Sec(s) Township Range: can be found in The Thomas guide
1/4 Section NE 19 Township T27N
Example 30 T29N
Range R4E
R5E
If requesting more than one Quarter Section fill out attached sheet -- see page 2.
Detail Protect Description (I.e. road widening with stormwater improvement: Residential Plat: etc.)
Subdivision of property with retention of existing house on proposed Lot 2. Lot 1 to construct new residence
with shared driveway, utility installation, and stormwater improvements.
Please Select One Yes No Unknown
FRONTAGE IMPROVEMENT IN RIGHT OF WAY x
FEDERAL FUNDS INVOLVED IN THE PROJECT x
UTILITIES RELOCATION REQUIRED FOR PROJECT? x
NOTE: By identifying utilities early in the design phase costly relocations may be avoided or minimized.
When you receive Puget Sound Energy facility maps you will also receive contact information to help and
provide your costs if your project area is impacted by PSE natural gas and/or electril facilities.
"IT'S THE LAW" - CALL TWO (2) BUSINESS DAYS BEFORE YOU DIG -
811 or 1.800.424.5555 or callbeforeyoudig.org form date 1/15/10