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e�n¢nols... re rnEr, <br />`a "`` KIT'PYiTAS COUNTY <br />46 <br />DEPARTMENT OF PUBLIC WORKS <br />KITTITAti COUNTY <br />FRANCHISE APPLICATION <br />Facility in County Road Right of WAY <br />Fee (Non -Refundable): $1,615.00 Payment Method:I Check ❑ Cash <br />Owner Name 82ETT C-�=P,R Permit#_t,F.L.4'' <br />Mailing Address $�20 tJ , Ftz eC, 0 5 o <br />Phone Number (SO -I 8`11 —a39"1 <br />Applicant Name SR rN E ✓� 5 R v C Nl'K L a 2313 <br />Mailing Address At; € € s z;r i.Jvvli' 1 f <br />Phone Number _ 0g:P4B. 1 Er wl(V <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 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: aa <br />Detailed Project Plans pou'tCI m bbo' 3✓ <br />Detailed Vicinity Map <br />Schedule for Work to be performed <br />Ste � 3 ,"7 ��/ 17, <br />0 <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 "I Date ti 12.7 /J0 <br />411 N. Ruby St. Suite 1 TEL (509) 962-7523 <br />Ellensburg, WA 98926 FAX (509) 962-7663 <br />