Engineering New Service

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Account Type

Account Type*

When applying for a business account, the person requesting service must be an employee and authorized guarantor of the business. In the case of a Sole Ownership or a Partnership, the request to set up service must be initiated by the owner(s)

How are you associated with this property?*

Landlords authorize Public Utility District No. 1 of Lewis County (District) to re-establish service in the Landlord’s name without further notification to the Landlord. The re-establishment of service will occur at the time the tenant terminates services with the District.

The meter will remain connected and the Landlord will be responsible for any daily basic and electrical consumption charges accrued between the vacating tenant and the new tenant.

The Landlord agrees to notify the District in writing of any changes in property ownership.

The District reserves the right to disconnect service for non-payment or for emergency purposes.

Failure by Landlord to make on-time payments will result in removal of the Landlord option.

The District will bill a $10.00 fee (Account Service Charge) each time service is established, or account responsibility is transferred to the Landlord.

I have read and agree to the above landlord notice.*

Yes

Customer Information

Full Legal Name of Primary Account Holder*

Type NMI for No Middle Name if necessary

First Middle Last

Business Name*

Full Name of Applicant*

Type NMI for No Middle Name if necessary

First Middle Last

Title*

Specify Other Title*

Mailing Address*

Street Address (Include Apartment or Suite Number) Address Line 2 City State ZIP Code

Phone*

Cell Phone

Work Phone

Email Address*

Social Security Number:*

Last 4 digits only

Date of Birth*

Driver License Number of Primary Account Holder*

State of Issuance for Driver License*

State

Employer of Primary Account Holder

Full Name of Other Responsible Party*

Type NMI for No Middle Name if necessary

First Middle Last

Relationship*

Joint Account Holder Phone Number*

Joint Account Holder Work Phone Number

Joint Account Holder Email

Joint Account Holder Social Security Number*

Last 4 digits only

Joint Account Holder Date of Birth*

Joint Account Holder Driver License Number*

Joint Account Holder Driver License State of Issuance*

State

Joint Account Holder Name of Employer

Business License Number*

Federal Tax ID Number*

Service Location Information

Service Type*

If "Other" please describe

If "Multi-Family" please specify number of lots or units

Property Parcel Number

For a development or multiple parcels, enter one parcel number. You can search for the parcel on Lewis County Parcel Search site.

Service Address*

*If the property does not have an assigned address, list the street name. *A service address will be required prior to service connection.

Street Address (Include Apartment or Suite Number) Address Line 2 City State ZIP Code

Directions to site

Include nearest cross street

Service Location Entrance*

No Lock

Key Lock

Gate Code

Combination

Code or Combination*

If Code or Combination, please type number here.

Lewis County Recorded Documents*

Please provide Lewis County Auditor File Number (AFN) for any existing site surveys or easements.

Are you using a Contractor, Developer, or Builder?*

Yes

Contractor Type*

Project Manager

Building Contractor

Electrical Contractor

Excavation Contractor

Project Manager Name*

First Last or Business Name

Project Manager Phone*

Project Manager Email*

Building Contractor Name*

First Last or Business Name

Building Contractor Phone*

Building Contractor Email*

Electrical Contractor Name*

First Last or Business

Electrical Contractor Phone*

Electrical Contractor Email*

Excavation Contractor Name*

First Last or Business Name

Excavation Contractor Phone*

Excavation Contractor Email*

Electrical Service

Temporary Service*

Temporary Service is only valid for one year from connection date. It will be disconnected when permanent service is energized.

Overhead

Underground

No Temporary required

Approximate Date Needed*

Site Use*

If Other, please describe.*

Request Service Type*

Overhead

Underground

Voltage Requested*

120/240 volts, 3 wire

120/240 volts, 4 wire

120/208 volts, 4 wire

277/480 volts, 4 wire

Electrical Service Entrance Size*

200 Amps

320 Amps

Other

If Other, please describe.*

Will there be a gang meter base?*

Yes

Number of Meters*

Will the service be larger than 400 Amps?*

Yes

Please provide Main Disconnect Size, # of Panels, and Sizes*

Electrical Load Information

You may need help from an electrician to complete.

Building Square Footage*

Type of Heat*

Electric

Gas

Wood

Furnace

Baseboard

Wall Heaters

Tankless Hot Water Heater

Other

Please provide the kW for the selected heating types.*

Motor Load*

Heat Pump - Soft Start Required

Air Conditioning - Soft Start Required

Welder

Other

Please provide kW, HP size, starting AMPs, LRA, and running AMPs for selected motor loads.*

Will you be installing Electric Vehicle charging?*

Yes

Please provide charger level and kW.*

Project Totals

Total kW of All Loads*

Anticipated Peak Demand*

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Existing Meter Number (Optional)

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Requested Activation Date*

We do not provide same day reconnects for online requests. Online service application requests must be made at least 3 days prior to the effective date of the transfer or reconnect.

Are there any outdoor animals the meter readers should be aware of?*

Type of animal*

Additional Project Information

Tell us about your project

Document Upload*

Please include any site plan and load calculation you may have. Attach pictures and/or a copy of any other relevant documents. i.e., Maps, drawings, plans, etc. *A copy of valid government issued photo identification is required for all responsible parties. Acceptable forms of ID include: *Valid State Driver’s License or ID Card *Passport *Military ID For Corporate accounts only: In lieu personal government issued identification, we will accept: *Company photo ID with a Letter of Authorization on Company letterhead.

Drop files here or

Max. file size: 30 MB.

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Date*

The applicant is subject to all of the provisions of the District resolutions establishing service policies and rates, which are by this reference incorporated into and made a part of this application. This application, when accepted by the District, becomes a contract committing the Applicant/Customer to pay for the electrical service furnished in accordance with the applicable rate schedules, including minimum charges, and for any unpaid service and charges previously rendered to the Applicant/ Customer by the District.

A non-refundable Account Service Charge (ASC) of $10.00 will be billed on your first statement after your service has been energized.

I hereby verify the information provided on this form to be true and complete. I understand that by typing my full name below and submitting this information, this form will be stamped with today’s date and authorized by me as if I had signed my signature. I certify under penalty of perjury of the state of Washington that I am the individual named in the electronic signature block.

Service Application Terms and Conditions*
I have read the Terms and Conditions

I have read the Customer Informational Brochure*
I have read the Customer Informational Brochure.

Signature of Applicant*
By typing your name below you agree that all information provided is correct and that you have read, acknowledge and agree to all of the terms and conditions of service listed above.

Signature of Joint Applicant*
By typing your name below you agree that all information provided is correct and that you have read, acknowledge and agree to all of the terms and conditions of service listed above.

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Questions & Comments

Email
This field is for validation purposes and should be left unchanged.

Engineering New Service

Application for New Electric Service

Account Type

Customer Information

Service Location Information

Electrical Service

Electrical Load Information

Project Totals

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