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t�:st mt:. rogr <br />'rtbr <br />'imps cnc�n <br />KITZ'ITAB COTJNT'Y <br />DEPARTMENT OF PUBLIC WORKS <br />FRANCHISE APPLICATION <br />Facility in County Road Right of WAY <br />Fee (Non -Refundable): $1.,615.00 <br />Owner Name <br />Mailing Address r'C <br />Phone Number <br />Applicant Name �': ""L /4,1, L <br />Mailing Address F'4"L- /15 14';+rV <br />Phone Number`��%`'1 "L^ 7— �7 -,":Z <br />Payment Method: 0 Check IO(jSSS p Cash <br />Permit # <br />DATESTAMP <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 terns 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 UNG 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 />EJ All required supporting documents have been attached. <br />lg Applicant agrees to obtain a work in Right -of -Way permit upon approval of the franchise agreement. <br />Applicant/Agent Signature Date _ <br />411 N. Ruby St. Suite 1 TEL (509) 962-7523 <br />Ellensburg, WA 98926 FAX (509) 962-7663 <br />