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o��wcpscpoes... ror�c C MB <br />00 <br />icrrrrrns cucrvrr <br />ZrLITTZTgIBi COUNTY <br />DEPARTMENT OF PUBLIC WORKS <br />FRANCHISE APPLICATION <br />Facility In County Road Right of WAY Q J X iJr" l bf a 1 } <br />Fee (Non -Refundable): $1,615.00 Payment Method: J$ Check ❑ Cash )9 Credit Card <br />Owner Name Consolidated Communications of Washington Company, LLC Permit # <br />Mailing Address 2116 South 17th St Mattoon IL 61938 <br />Phone Number 724-449-2545 <br />Email Address Mike.Shultz@Consolidated.com <br />Applicant Name Floyd Jasinski (on behaff of Mike Shultz) <br />Mailing Address Same As Above <br />Phone Number 916-786-1597 DATE STAMP <br />Email Address floyd.jasinski@consolidated.com <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 />Supportine Documents Required for complete application: <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. Note: Applicant previously provided to county <br />J� 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 />f2)�� <br />Applicant/Agent Signature Date October 31, 2023 <br />411 N. Ruby St. Suite 1 TEL (509) 962-7523 <br />Ellensburg, WA 98926 FAX (509) 962-7663 <br />