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i <br /> City of Eugene <br /> Public Works <br /> 'lpplication fo Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> glob Number: ~~~1!~ Eugene, OR 97401 <br /> (541) 682-5291 <br /> FAX: (541) 682-5032 <br /> Contract No: <br /> ~ C'LL~ St. 1 -7 /E~ hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (owner) <br /> Construct public im rovements in the public way, as described below: <br /> Type of improv ment: ~ <br /> (paving, wastewater, storm ter, street lights) <br /> "r0~~ ~t~1Ot~ <br /> Location: <br /> l (street or easement work is within or subdivision name) <br /> North (or east) imit~ ~ South (or west) limit: 2~ ~1, <br /> strict conforman a with City of Eugene standard specffications for public improvements (including current addenda), <br /> Construction plans proved by the city engineer or his representative, the current edition of "Procedures for Privately Engineered <br /> ~rojects," the Euge a City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> Responsible for pro ding a copy of this permit to the contractor performing the work. <br /> contact Person ~ C Gt: fs 2 ~ . ~'j l~~ <br /> 1~~ t ~ G~ +~1-C~~ <br /> i;ignature Mailing Address ~~i'~~~' <br /> ~G'V Sz. /1'! i~~s <br /> print signature here ~ <br /> ate Phone City /State /Zip - L~~ L~ 777 <br /> i 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 /> 1'he permft shall be oid unless the work described herein is completed by: <br /> ~PECIAL CONDITI NS <br /> APPROVED: Date: <br /> City Engineer <br /> <br /> Eng: 604 FEBRUARY 2002 <br /> Whfte: OwneNDesipner Canary: Contractor Pink: Inspector <br /> <br />