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City of Eugene <br /> Public Works <br /> ~pp[ication r Public Improvemen# Permi# Erngineering <br /> 858 Pend Street <br /> ' Eugene, OR 97441 <br /> Job Number. {549) 682-5292 <br /> FAX: {541 }682-5432 <br /> ' Cotrtract hlo: <br /> i, Yv1ak4- k A,VL r K.P FF hereby make application for a PuBUC IMPROVEMENT PERMIT to: <br /> (~4 <br /> i construct public i provemerrts in the public way, as described below: <br /> II I J <br /> i Type of Imp vernent: S~-t C.X~F.t.~~%,on ~ WC-~~J'~• WC~~e-l. Q.r'tq S~ wt U-~ <br /> (paving, w~Sta+irater, storrnwater, s~Sreet Ilghts) ~X~-Sl. t7YLs . <br /> I <br /> d t,~ h~~ ~ T sow <br /> location. ~ W U ~G ~ <br /> (street of wodt is WilFtin ar subifivision rl8rtle) <br /> Z ~ ~ n at-~ ~ ~Z . <br /> North (or ens }limit: ~ South (or west} limit: <br /> ~I <br /> in strict confo nce with City of Eugene standard specifications for public imprtwernents (including current addenda}, <br /> construction plans proved bythe city engineerorttis representative, the currentedition of `Procedures for privately Engineered <br /> Projects," the Eug a City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> li responsible for pr iding a copy of this permit to the contractor perfarming the work. <br /> II Contact Person ~Q.'~ <br /> i <br /> ~ Signature V~a~ Mailing Address ~Z ~ ~ Oa-~ St • sf`~ l b.(L <br /> Printsignature he ~S <br /> Date ~ ' 3 ' Phone ~ ~ ~ ' `f ~0 2 City / State I Zip `~`'L~. O R- Ql "7 ~U l <br /> I <br /> oo xor wrurE eEl..ow mes tme <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is he y granted to applicant and applicant's contractor to perform the work stated above, in conformance with <br /> i, conditions listed ve, below, and on the reverse side of this permit form. <br /> The permit shalt be void unless the work described herein is completed by: <br /> SPECIAL GONDlT HS <br /> I',APPROVEt7: Date: <br /> City Engineer <br /> I <br /> <br /> Eng; 604 F~uaRr 2002 <br /> wWIB:OvrtserlDesigner Car~a,y. ContrBGot r4nk Inspector <br /> <br />