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<br /> . ~ City of Eugene <br /> ~ Public Works <br /> Application for Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> Job Number. f "1 ~J ~ ~ Eugene, OR 97401 <br /> (541)682-5291 <br /> FAX: (541)682-5032 <br /> Contract No: <br /> I~ hereby make application for a PUBLIC IMPROVEMENT PERMIT to= <br /> c~~ <br /> construct public im rovements in the public way, as described below: <br /> Type of Impro ment: ~T`~'-/~W.~>~' ~C~~~~ <br /> (paving. wastewater. stonnwater, street lights) <br /> Location: ~ ~ V ~ E ) i~E7~ A~c~l~V~ LT~(~% t', L/ IUe't~L- I~ <br /> (street or easement work is within or subdivision name) <br /> North (or east) limit: C{tph~~ 5 / South (or west) limit: N ~ ~ N 5 T <br /> V ih strict conforman with City of Eugene standard specifications for public improvements (including current addenda), <br /> Construcgon plans proved bythe aty engineeror his representative,the current edition of °Proceduresfor Privately Engineered <br /> projects," the Euge a City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> riesponsible for p iding a copy of this permit to the contractor performing the work. <br /> Contact Person ~ ~ G 'rte ~ ~ ~ <br /> Signature Mailing Addressl <br /> Print si nature her C `r ~ <br /> date g - 2 - Phone - -6a'3 - City /State / Zp C~ NfiC''~D~ ~ <br /> no t~ wartE eeww Ttas ~ <br /> PUBLIC IMPROVEMENT PERMIT <br /> permission is he y granted to applicant and applicants contractor to perform the work stated above, in conformance with <br /> conditions listed ve, 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 /> i <br /> SPECIAL CONDIT ONS <br /> I <br /> i <br /> ,~4PPROVED: Date: <br /> City Engineer <br /> Eng: spa FEBRUARY 2002 <br /> Wlfite: OwnedDesigner Canary: Contractor Pink: Inspector <br /> <br />