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�.sc roes... io �eCp <br />5 (� <br />AITTITAS COUNTY f <br />KZTTZTAS COTTNTY <br />DEPARTMENT OF PUBLIC WORKS <br />FRANCHISE APPLICATION PKC a5 L4 <br />JL4 <br />Facility in County Road Right of WAY <br />Fee (Non -Refundable): $1,615.00 <br />Owner Name -7,,,,, f <br />Mailing Address_ 1210 <br />W1 <br />Payment Method: Cheek i A93 ❑ Cash <br />tv,enLtC <br />If -1z4 <br />Phone Number 7V U- 3 c S- '3 S 3 �/ <br />Applicant Name % 1 wi 0 ti i e o l4 <br />Mailing Address 210 N £a f 3 "a A v -r0. u <br />016 IT 7 - <br />Phone Number 20(L — 30s,- 3S <br />Permit # Ff__ "l <br />ions onend do lc <br />JllNnoo suillm <br />810z 0 £ ads! <br />DATE STAMP <br />If request is for agricultural or residential use continue with this application If not <br />applicant shall use the Franchise Complex application <br />Pursuant to KCC 15A.03.040, upon receipt of the application, Kittitas County Public Works will <br />contact the applicant to schedule a meeting with the Director of Public Works and/or the County <br />Engineer to discuss terms and conditions of franchise agreement and schedule a Public Hearing for <br />consideration of the franchise agreement by the Board of County Commissioner's. <br />Supporting Documents Required for complete application: <br />• Detailed Project Plans <br />• Detailed Vicinity Map <br />• Schedule for Work to be performed <br />CALL BEFORE YOU DIG 1-800-424-5555 or 811 <br />Applicant is responsible for calling for underground utility locates 48 hours prior to construction. <br />Warning: The County does not mark any of the County infrastructures; the Applicant is responsible for any damage <br />to the County infrastructure. <br />ir_y/ All required supporting documents have been attached. <br />�( Applicant agrees to obtain a work in Right -of -Way permit upon approval of the franchise agreement. <br />Applicant/Agent Signature <br />Date <br />3130//6 <br />411 N. Ruby St. Suite 1 TEL (509) 962-7523 <br />Ellensburg, WA 98926 FAX (509) 962-7663 <br />