Sample Only

Lacey, WA
Application for License or Franchise

Applicant ___________________________________________________________________

Address ___________________________________________________________________

Represented by ____________________________________ Telephone _________________

Provide copies of registration filed with and issued by the Washington Utilities and Transportation Commission pursuant to WAC 480-121 and any approved tariff or price list and permit, operating license or other right or approvals issued by the Federal Communications Commission to provide telecommunications services.

Detailed information on the following must be attached. The following represents a summary of relevant data.

Service proposed _____________________________________________________________

___________________________________________________________________________

Route or area to be served ______________________________________________________

(Attach preliminary engineering plans and sufficient explanation to identify where facilities are proposed to be located within the city.

Applicant proposes to install lines:

Underground in existing conduits_____Underground in new conduits______Overhead______

(In each case, evidence must be provided by the applicant that sufficient surplus capacity exists, including underground utilities in place in proposed route, height of lines if overhead, the amount of surplus capacity remaining after installation of the applicant's facilities, and evidence of ownership or right to use of facilities. NOTE: At the permitting state the following detailed information will be required: overhead and underground electric, cable, telecommunications, natural gas, water, sewer, storm facilities; location(s), if any, for interconnection with facilities of other telecommunications providers should be noted. Specific trees, structures, improvements, facilities, and obstructions, if any, that the applicant proposes to temporarily or permanently remove or relocate should be identified.)

Owner of existing facilities _____________________________________________________

____________________________________________________________________________

Proposed construction schedule and completion date _________________________________

If applicable, describe services presently provided inside the city and when these services began_______________________________________________________________________

____________________________________________________________________________