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KITTITA45 COUNTY <br />DEPARTMENT OF PUBLIC WORKS <br />FRANCHISE APPLICATION S l t}t ISM <br />`Q <br />Facility in County Road Right of WAY <br />Fee (Non -Refundable): $1,615.00 Payment Method: V Checkl;gq � i ❑ Cash <br />Owner Name I V1 e, 1'�" u h C - <br />Mailing Address P. 0 <br />Phone Number <br />Applicant Name_ <br />Mailing Address <br />C <br />Phone Number <br />Permit #- K IR- voo <br />FEB U 1 2019 <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 IBeouired 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 />❑ 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 �VV✓t/f W I V �(�i (/fA Date <br />411 N. Ruby St. Suite 1 TEL (509) 962-7523 <br />Ellensburg, WA 98926 FAX (509) 962-7663 <br />