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lication for Public Improvement Permit <br />Job Number: ~~~ <br />City of Eugene <br />Public Works <br />Engineering <br />858 Pearl Street <br />Eugene, OR 97401 <br />(541) 682-5291 <br />FAX: (541) 682-5032 <br />Contract No: <br />~ e3 ~.~ ~•T >~7~-~~ LL ~ <br />~, ~°~ ~ l~-I ~`''r"` ~~ y' hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br />(owner) <br />construct public improvements in the public way, as described below: <br />Type of Improvement: ~~1,9~'~~" >~l'~S~'E-1l`( d ~E2 , 5'Tu-2w-. \/.~e~ l~.2 ?~.~C'( ~i~ ft~5 G.~~ <br />(paving, wastewater, stormwater, street lights) <br />Location: ~~~'~~~- ~~~~~- <br />(street or easement work is within or subdivision name) <br />-~-~ <br />North ( east) Iimit: ~~"~ ''''- ~"~- ~ South (o west) limit: ~L~ GL~ ~~ ~~~"~Z` ~~ <br />in strict conformance with City of Eugene standard spec'rfications for public improvements (including current addenda), <br />construction plans approved by the city engineer or his representative, the current editiori of "Procedures for Privately Engineered <br />Projects," the Eugene City Code, and the standard and special conditions printed on this permit form. The ownedapplicant is <br />responsible for providing a copy of this permit to the contractor performing the wbrk. <br />Contact Person ~p~,~ ~' `'t- ~G rs~.~ ~n~~~ ~~"'~"''~~~'~'~ °~ <br />Signature ~ ~~, b-~~ Mailing Address ~'t3 ~ ~~``9 ~~~7 I ~s ~'`~ ` <br />Print signat re here ~ r~"i ~ L ~-~a ~'I Sk y <br />Date Phone S `~/ ~ ~ ~ ~ ~~ % ~ ~City / State / Zip (3 ~~~, ~'~- ~ 7 7 `' ~ <br />DO NOT WRITE BELOW THIS LINE <br />_ _ _ ~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ _ _ - _ _ _ <br />PUBLIC IMPROVEMENT PERMIT <br />Permission is hereby granted to applicant and applicanYs contractor to perform the work stated above, in conformance with <br />conditions listed above, 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 />SPECIAL CONDITIONS <br />APPROVED: <br />City Engineer <br />Date: <br />E(lg: 604 FEBRUARY 20R2 <br />WhRe: OwnedDesigner Canary: Corrtractor Pink: Inspector <br />