Current Start Preview Complete Name (first and last) Mailing address Service address Primary phone # Phone Email Type of building project: Mobile home Manufactured/Modular home Conventional home Pole shed/Garage Addition to existing structure Other: Describe project: Please describe in full the changes to be made on your electric service: Meter location Underground to building Overhead to building Underground post or pedestal What side of the building is the meter socket located on? North South East West N/A Other… What side of the building is the meter socket located? Service size 200 amp 320 amp 400 amp 600 amp Other: Other size Which of the following appliances/utilities are electric? Water heater Primary heat Secondary heat Clothes dryer Central air conditioning Window air conditioning Kitchen stove Shop welder Other large appliances (electric) Enter other electric appliances Who is doing the electrical work? Contractor phone number Please enter contractors phone number I would like to meet with the Polk-Burnett engineering technician onsite - Select -YesNo Optional: Upload document with site design. Please include any of the following: Lot dimensions Location of building relative to street Desired location of meter Septic and drain field Future buildings Any other pertinent information related to your project. Upload site design (optional)? Please indicate lot lines, dimensions, location of house relative to the street, desired location of meter on building, septic and drain field and anything else pertinent to your project. One file only.20 MB limit.Allowed types: txt, pdf, doc, docx, ppt, pptx, odp, xls, xlsx, ods. Signature? Please sign above (you can use your mouse on a computer or your finger/stylus on a touch screen) Date? CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Leave this field blank