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Qpo� noes...'ro rr��oCGyB4 <br />wnirns couMrr <br />KZTTZTAS COUNTY <br />DEPARTMENT OF PUBLIC WORKS <br />411 North Ruby Street, Suite 1, Ellensburg, WA 98926 <br />TEL (509) 962-7523 FAX (509) 962-7663 <br />FRANCHISE APPLICATION <br />FOR FACILITYIN COUNTYROAD RIGHT-OF-WAY <br />��(l� <br />�Qc Fee Schedule <br />Commercial and Residential Application - Vittitas County Department of Public Works (Non - <br />Refundable): $750.00 <br />This form precedes the legal agreement set forth by the county when applying for use of road right of way for <br />a franchise facility installation. The legal document is required by Kittitas County Code 12.56 specific to <br />Electrical, Telephone, Natural Gas, Cable TV, Sanitary Sewer, Domestic Water, or Irrigation Water which is <br />designated for commercial use and distribution. <br />Please type or print clearly in ink. Attach additional sheets as necessary. Pursuant to KCC 15A.03.040, a <br />complete application is determined within 28 days of receipt of the application submittal packet and fee. <br />Owner/Applicant W' T 7 p 4f, Date/ I o� I b <br />Addresslill huff( Yo City StateWAZip%y( <br />Phone <cq 6IL4 -61{,51 E-mail i K t <br />Type of Franchise <br />Affected County Road <br />Assessor's Parcel No.1644y , a1031 <br />Please provide a brief description below of the proposed franchise: <br />WE AKE O.a&Tnl ani 6WLE OX(bARD MI EI*Ea P&KEr .Zv (74AF7 <br />Kittitas County expects t entities applying for use of county maintained right of way specifically address <br />public benefit when applying for franchise and associated right of way use. Please provide a brief description <br />of the public benefit supported by this application (please attach supplement sheet as necessary): <br />'i7a Le#,g Sp m F -w -7Wif eAj jo RWfIL 91037 hhu- At4w inf 're <br />cc�55Fcccy Frwoi I hUi AW F tm4 r1off IkknyYu7t9 To TY�►r i�9cr <br />by (PW Staff Signature) <br />on 09/09/2016 <br />Date: Receipt # <br />✓`�i�� <br />