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City of Eugene <br /> Public Works <br /> <br /> Application f r Public Improvement Permit Engineering <br /> _ 858 Pearl Street <br /> Job Number. LJ ~ Eugene, OR 97401 <br /> i (541) 682-5291 <br /> FAX: (541) 682-5032 <br /> Contract No: <br /> 1, SfTiA, ~ t.6Tb ~ hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> load <br /> j, construct public i provements in the public way, as described below: <br /> Type of tmpro ement: _~J Gy 1z.8 S'I5~.~.wAT~ <br /> (paving, wastewater, stormwater, street lights) <br /> i <br /> Location: ~?1D os <br /> (street or easement work is within or subdivision name) <br /> 1 <br /> North (or east limit: ti3at ~LS~', South (or west) limit: 3ZS ~ / a'~Sc~t"101'f1 <br /> in strict conforma ce with City of Eugene standard specifications for public improvements (including current addenda), <br /> construction plans pproved bythe city engineer or his representative, the current edition of "Procedures for Privately Engineered <br /> Projects," the Eug ne City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> responsible for p iding a copy of this permit to the contractor performing the work. <br /> Contact Perso ^rbnl ST3~~ar~, <br /> Signature Mailing Address PO ~4S"o S <br /> Print signature her _ <br /> Date Phone S~ Sc]3i City /State / Zip ~[3.-~ 47 ~J2- <br /> I <br /> DO NOT WRITE BELOW THIS LINE <br /> PUBLIC IMPROVEMENT PERMIT <br /> +Permission is here y granted to applicant and applicant's contractor to perform the work stated above, in conformance with <br /> ~COnditions listed ab 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 /> rSPECIAL CONDITI NS <br /> I <br /> I <br /> WPPROVED: Date: <br /> City Engineer <br /> Eng: 6h4 FEBRUARY Zoa7 <br /> white: ownerlDesigner Canary: Comraclor Pink Inspector <br /> <br />