Temporary Application

CUSTOMER BILLING INFORMATION

Grant PUD Billing Account Number*

Account Number can only contain numbers

Primary Customer Name*

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Mailing Address*

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City*

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State*

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Zip*

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E-mail Address*

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Phone*

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Secondary

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Do you have a person, contractor or engineer that represents you on this project?*

Yes

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Primary Contact Person/Contractor*

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Phone*

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E-mail Address:*

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SERVICE LOCATION

Please select one and provide info:*

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Plat Name

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Lot Number

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Address*

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Parcel Number*

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Plat Phase

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City*

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Block Number:

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Zip*

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SERVICE REQUEST TYPE:

Anticipated KW Demand

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Service Size in amps*

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VOLTAGE INFORMATION

Voltage*

Single Phase 120/240

Three Phase 120/208

Three Phase 277/480

Other

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Please Specify*

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Installation Type

Underground

Overhead

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Service entrance feeder

Phase wire size

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Number of runs

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Neutral wire size

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Wire Type

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SITE PLAN

Do you have a site plan? *

Yes

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Please tell us why*

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Please attach*

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RIGHTS AND OBLIGATIONS

Public Utility District No. 2 of Grant County, Washington (Grant PUD) will build the necessary electrical facilities on your property. In return, you give Grant PUD permission to construct, operate, patrol, maintain, and remove overhead and/or underground electrical distribution lines and related equipment to include; Fiber optic and gateway facilities.

Grant PUD maintains the right to clear the area where the distribution equipment and fiber optic facilities are located on the customer's property. Grant PUD will also ensure the property is kept clear of brush, trees, timber, structures, improvements, and all fire hazards around our equipment.

The customer agrees to not place, construct, or maintain any building, structures, or other improvements within a 10-foot area of Grant PUD electrical or fiber optic facilities. The customer agrees not to reduce or enlarge the required minimum clearances between the ground and any overhead or underground power or fiber optic lines. Failure to comply with these requirements will result in Grant PUD enforcing the requirements at the expense of the customer.

Legal Landowner of Record Signature

Your signature indicates you have read and agree to the Conditions stated in the “Rights and Obligations” section. The customer understands the work requested and authorizes Grant PUD to begin work as listed on the Service Connection Agreement form.The customer agrees to pay all charges associated with Construction.

Print Name*

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Signature*

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Date*

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