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4 <br /> Application or Pll~blic Improvement Permit City of Eugene <br /> _ Pubfic Works Engineering <br /> ' ~ 858 Pearl Street <br /> Eugene, OR 97401 <br /> Job Number ContractNumber sa1.682sz91Pnone <br /> O 541.682.5032 Fax <br /> ,I <br /> 11, Metro Corp. / Cit of Eug Parks hereby make application for a PUBLIC IMPROVEMENT PERMIT to construct public improvements <br /> ~ (owner) <br /> ~n the public way, s described below: <br /> Type of improve ent: Grading, Paving, Stormwater, Illumination <br /> (paving, wastewater, stormwater, street lights) <br /> Location: Prairie View Affordable Housing -Unthank Street <br /> (Street oreasement. work is within or subdivision name) <br /> ' North (or east) li it: Danebo Road South (or west) limit: Unthank Street <br /> I <br /> ih strict conforman with City of Eugene standard specifications for public improvements (including current addenda), construction <br /> i, plans approved by t e city engineer or his representative, the current edition of "Procedures for Privately Engineered Projects," the <br /> Eugene City Code, a d the standard and special conditions printed on this permit form. The owner/applicant is responsible for providing <br /> ~ copy of this permi to the contractor performing the work. <br /> Contact Person ( ri t) ichbr m Robin Hostick Phone Number (541) 683-1751 / (541) 682-4800 <br /> ~Cly/W~ ~ - f7c lam. <br /> SI N RE <br /> n L~ ~ Billing information: <br /> <br /> ,y, ~ ~ ~ P NT SIGNATURE <br /> VV ~ SCam'e ~~//D/Ji~~ff/e~rent, see below G <br /> D TE ..-~f M4 ~ / ? I ~ <br /> 430 Pearl St., Ste. B ! 1820 Roosevelt BI~o NAME <br /> ' M (LING ADDRESS <br /> ugene, OR 97401 /Eugene, OR 97402 BILLING ADDRESS <br /> C /STATE/ZIP <br /> (41) 683-1751 / (541) 682-4800 crrv/srATE/ZIP <br /> PH E NUMBER (business hours) <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is hereby ranted to applicant and applicant's contractor to perform the work stated above, in conformance with conditions <br /> lisped above, below, nd on the reverse side of this permit form. <br /> I <br /> 'Trye permit shall be v id unless the work described herein is completed by: <br /> SPECIAL CONDITIONS <br /> APPROVED: DATE: Original tothe,CityofEugene ' <br /> City Engine r Copies to Owner, Ca-owner, and Inspector <br /> I <br /> <br />