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K:ITTITAS COUNTY <br />DEP ARTMENT OF PUBLIC WORKS <br />411 North Ruby Street, Suite 1, Ellensburg, W A 98926 <br />TEL (509) 962-7523 FAX (509) 962-7663 <br />FRANCHISE APPLICATION <br />FOR FACILITY IN COUNTY ROAD RIGHT-OF-WAY <br />Fee Schedule <br />Commercial and Residential Application -Kittitas 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/APPlica.nt ~~. ·IRW'&j ~If /~ ~;'. ~:i~~-R~ Address 1111 Rli~D __ city ___ *_""'J!-,,:,-~.ILJ--__ _ <br />Phone 5cA -b5Y -611fL E-mail ni I(@Ja .~ ..f-.i( <br />Date l 110 /Ib <br />State WA Zip Ci't~QJ, <br />Type of Franchise .::::e:I..=::J-f(,-,+,7(-,-,16=<L!.tfT7~~J.L/----:=-__________ _ <br />Affected County Road-",Utw~IUJI{ ... fA .... J,~(£'---c:,:-,Rj ..... D,-,-. __________ _ <br />Assessor's Parcel No . -I-1 ..... 64 ..... 9->-Y-'--+-, -'<d-'-'-1,.><.O ..... U4--__________ _ <br />Please provide a brief description below of the proposed franchise: <br />WE ttKi PLttIJfl1\4 IW 8PPLE OKOftJfm 1M ~l PotI(F:I,:£v OlOEil <br />LA.trrEAl£ iSoAl> WITH F'VL f} PIE r <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 />~O(/tQtl/('f )PJ?'IIIKJ.iJ{ :J]7V{(GttncN To P{b7CfL ~1037 WILL t1tJ.a,; (£ -M <br />I A Ii ation R. ecniv.ed by (PW Staff Signature) <br />,oCt- <br />Date: <br />Revised on 09/09/2016