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Submit the original application to: <br />Kittitas County Department of Public Works <br />411 N. Ruby, Suite #1 <br />Ellens burg, W A 98926 <br />Applicant Certification <br />Certification is hereby given that the information provided is accurate and the applicable attachments are complete and <br />included as part of the application package . <br />s are met at the time of application . <br />-t-~/~/3.!_/h ___ Date <br />Signature of Agency Representative <br />Typed or Printed Name <br />Sponsoring Agency <br />(If Applicable) <br />Date <br />Date <br />Associate Economic Development Organization Notification <br />The organization listed below has received notification of this project as demonstrated by the signature of the <br />organization's representative. <br />6/ r) )20 t-£ <br />14