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Application for Public Improvement Permit <br />City of Eugene <br />Public Works <br />Engineering <br />_.~.-° <br />Job Number: 6".~ <br />858 Pearl Street <br />Eugene, OR 97401 <br />(541) 682-5291 <br />FAX: (541) 682-5032 <br />Contract No: <br />l• ! ~ ~--/ ~ ~~~~ hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br />(owner) <br />construct public improvements in the public way,. as described below: <br />Type of Improvement: <br />(paving, <br />Location: <br />street lights) <br />®~ ..~. (street or easement work is within or subdivisionf~name) <br />North (or east) limit: RaO,.St1 ~[.e.t ~ D ~~ South (or west) limit: 1~~Q~~~ `~ °~ "~~ <br />in strict conformance with City of Eugene standard specifications for public improvements (including current addenda); <br />construction plans approved by the city engineer or his representative, the current edition of "Procedures for Privately Engineered <br />Projects," the Eugene City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br />responsible for providing a copy of t(h~is permCit~to the contractor performing the work. <br />Contact Pe son (prinn ~`r°~ lJ~~c~l~ <br />Signatu a Mailing Address ~• n . 1 b / ~~_ <br />Print signatrre here rl ~~1n -7 nn <br />Date ~"~' !~~ Phone ~~ ~~' % ~ ~ "" Z~II City /State /Zip / ~(J <br />DO NOT WRITE BELOW THIS LINE <br />PUBLIC IMPROVEMENT PERMIT <br />Permission is hereby granted to applicant and applicant's contractor to perform the work stated above, in conformance with <br />conditions listed above, below, and on the reverse side of this permit form. <br />The permit shall be void unless the work described herein is completed by: <br />SPECIAL CONDITIONS <br />APPROVED: <br />City Engineer <br />Date: <br />Eog: 604 FEBRUARY 2002 <br />White: Owner/Designer Canary: Contractor Pink: Inspector <br />