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�u�vrcti aawry <br />3KY1=YYAlS V®Vi%Tf Z <br />DEPARTMENT OF PUBLIC WORKS <br />FRANCHISE APPLICATION <br />Facility in County Road Right of WAY <br />Fee (NonRefundable): $1,615.00 <br />Owner Name -David. <br />Mailing Add/ggss 06 MO'F '✓c'NrtQ <br />Phone Number 360 y q__20 -, 5P61 <br />Applicant Name <br />Mailing Address <br />Phone Number <br />Payment Method: � Check I i 1 I O Cash <br />Permit#�� <br />DATE STAMP <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 />Su000rtine Documents Required for complete application: <br />• Detailed Project Plans <br />• Detailed Vicinity Map batr-Its RC <br />Schedule for Work to be performevel N <br />d <br />CALL BEFORE YOU DIG 1-800424-5555 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 />13 All required supporting documents have been attached. <br />O Applicant agrees to obtain a work in Right -of -Way permit upon approval of the franchise agreement. <br />Applicant/Agent Signature "—�- ./r t�f/Y�4A Date <br />411 N. Ruby St. Suite 1 TEL (509) 962-7523 <br />Ellensburg, WA 98926 FAX (509) 962-7663 <br />