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xrrrfr&s MUM <br />3EKIWWXWAL13 CO <br />DEPARTMENT OF PUBLIC WORKS <br />FRANCHISE APPLICATION <br />Facility in County Road Right of WAY <br />Fee (Non -Refundable): $1,615.00 Payment Method: I-0 Check 13 CasoduCredit Card <br />Owner NameE✓J�Jhi`�4 � ,�.d� e,.f Rs.ti C.),IJI <br />Mailing Address <br />o <br />?,-1-, <br />S' I <br />c.JA- <br />�o2 <br />Phone Number <br />0 <br />- 5-14-5 <br />Email Address <br />s •cam <br />[ <br />e.,4 01/ <br />Applicant Name <br />55 <br />[vl'-"14n <br />Mailing Address <br />L -76i <br />S ?-.4-+"' <br />Phone Number S0 6 -SI( <br />Email Address _._ s"w. 41. a-, Q Aw, cu,, . <br />Permit # 91-00001 <br />RECENT <br />I(ITTITAS COUN'. <br />I Uf PUBLIC WORKS <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 />Supportina Documents Re uired for complete a licatiou: <br />• Detailed Project Plans <br />• Assessor's Map Number(s) <br />• Detailed Vicinity Map <br />• Schedule for Work to be performed <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 />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 acknowledges that Fee includes 6 hours of review. Any work beyond hours included in <br />said fee will be billed monthly at an hourly rate of $243.00. <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 />