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^yU.oes...m:ge`Di <br />KR1rG5lDIP.�"IY <br />3H131TTZTA61 COUNTY <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 Addi <br />Phone Number <br />Applicant Name .SiQ'l'�l 45 4SO Jr <br />Mailing Address <br />Phone Number <br />Payment Method: R heck5114 ❑ Cash <br />Permit o_E c_1- 0= <br />kE-vF-,1VE1 <br />S21 <br />KITMAS COUNTY <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 Required 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 />Waming: 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 awoork inRight-of-Waypermit upon approval of the franchise agreement. <br />ti`s <br />Applicant/Agent Signature �✓ ' `�v � Date 3—ZS-2l <br />411 N. Ruby St. Suite 1 TEL (509) 962-7523 <br />Ellensburg, WA 98926 FAX (509) 962-7663 <br />