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EASEMENT APPLICATION
No. _________
(200____)
APPLICANT - Individual
Name______________________________________________ Phone No.______________
Address___________________________________________
City___________________
County________________State_________Zip_____________
APPLICANT - Corporation ***
Local Office__________________________________
Agent_______________________
Address_______________________________________ Phone No.___________________
City___________________ County________________ State________
Zip___________
Headquarter Office____________________________
Manager_____________________
Address____________________________________________________________________
City___________________ County________________ State________
Zip___________
I hereby apply for an easement on the portion of the City-owned property as illustrated on
page two for the following purpose(s):
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Legal description of property:___________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Located in Section_________, Township___________,
Range____________E., W.M.
Enclosed is my check for the initial administrative fee of $100.00 to establish the requested
easement. Make checks payable to Seattle City Light.
This administrative fee will be returned if this application is denied by Seattle City Light.
I understand that in addition, if the application is approved, a fee based upon the fair market
value of the easement area will be charged For this easement, plus any applicable state, county,
or city taxes.
Signed______________________________________ Dated__________________________
(Applicant)
VICINITY MAP AND LOCATION OF PROPOSED EASEMENT AREA Scale____________
(Please show streets, buildings, fences, or other features which relate to your request.)
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