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PERMIT APPLICATION
APPLICANT
Name_________________________________________________
Phone No.___________
Work
Company______________________________________________
Phone No.___________
Home
Address______________________________________________
State____Zip________
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I hereby apply for permission to temporarily use the
portion of City-owned
property as illustrated on the REVERSE SIDE for the
following purpose(s):
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
LEGAL DESCRIPTION of Permit
Area:____________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Located in Section_________, Township__________,
Range__________E.W.M
ENCLOSED is the Administrative Fee to process the permit.
Make checks payable
to Seattle City Light.
[ ] COMMERCIAL $100.00 [ ] RESIDENTIAL or AGRICULTURAL
$50.00
(Administrative Fee is non-refundable unless the use is
denied by City Light)
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It is understood that in addition to the Administrative
Fee, an annual (or
monthly) fee will be assessed, in advance, based upon the
fair market value,
plus any applicable state, county or city taxes. It is
also understood that
all permits issued by City Light may be cancelled at any
time upon 30 days
written notice.
Signed____________________________
Dated________________________________
Applicant
VICINITY MAP AND LOCATION OF PROPOSED PERMIT AREA
Scale_____________
(Please show streets, buildings, fences, or other
features which relate to your request.) |