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Seattle City Light <br />700 Fifth Avenue <br />Suite 3644 <br />Seattle, WA 98104 -5031 <br />POLE ATTACHMENT APPLICATION AND PERMIT <br />City Light Map <br />and Pole No. <br />PERMIT <br />Master Pole Attachment Agreement <br />In accordance with the terms of the Agreement between us, dated <br />19 application is hereby submitted for a permit to make attachment to <br />poles, as follows: <br />Pole Location <br />APPENDIX B <br />By: <br />Title: <br />Date: <br />Address: <br />Type of <br />Attachment <br />Area Name <br />Marked location map attached. Attach additional sheets of locations /numbers as needed. <br />SUB is hereby granted for attachment to above poles as shown, and /or corrected, <br />on the list and map. <br />For applicants without Master Pole Attachment AEreements. permission to attach may be <br />revoked by the Department 180 days after providing written notice to the applicant. <br />B1 <br />By: <br />Title: <br />Date: <br />