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~1 <br /> ~-ei~1 <br /> <br /> • City of Eugene <br /> Public Works <br /> Application for Public Improvement Permit Engineering <br /> _ ~ 858 Pearl Street <br /> Job Number. - L~ ~ Eugene, OR 974Q1 <br /> (541)682-5291 <br /> Contract No: FAX: (541)682-5032 <br /> I, ~ ~-r c r^~~, hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (mod <br /> construct public improvements in the public way, as described below: <br /> ~ Type of Improvement: I"~Q,V~ l~~l C G . i~l/a-~Ci.U4 JP~, S~oCP t.Ugl~S <br /> ~ (paving, wastewater, stormwater, street lights) <br /> Location: 1~2/1tJe ~ 1..LtU/t'W1- ! ~ I )~'f <br /> I <br /> 1 r (street or easement work is within or subdvlslon name) <br /> North (or ast Iimi>»~~/ ~ ` Dh ~~t°l~'I' South (ot~ limit: L.GLUPF(~I fl <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 permft form. The owner/applicant is <br /> responsible for providing a copy of this permit to the contractor performing the work. <br /> Contact Person tw?~4 ~ ull/1 SLl1 yf~S ' <br /> Signature Mailing Address q ~ la • ~ ~ <br /> Print signet a he a efc r t..-, I^. <br /> Date ~ t ` Phone~`I' ~ ~`fi 3'~ City /State /Zip fit", ~ ~ ~ ~ G ~ ~ ~ 3 <br /> DO NOT VYRRE BELOW THIS LINE <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission Is hereby granted to applicant and applicants 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: Date: <br /> City Engineer <br /> I <br /> I <br /> En :6b4 <br /> VVt~te: OwnsdDesigrbr finery: Gontrector PIMc Inspector FEBRUARY 2002 <br /> <br />