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! ~ ~ ~ ~ <br /> f~ t~ e„ ~ <br /> ...~--y 1 ' ~ r~- <br /> 'PRO-ACT AUTHORIZATION FORM Engineering <br /> o - Public Works <br /> I <br /> City of Eugene <br /> 244 E. Broadway <br /> ..hh Eugene, OR 97401 <br /> f M" (541)682-5560 <br /> ~ 'Service ID: SID ~ PB~ GL " JC ~ JE <br /> Project title: <br /> (/ocatio and work desciiplionJ l <br /> ~?,tiriu.a ~ ~ t~ <br /> j .rh,u., ~,~,T Sf <br /> r~P~~ //~J/~~~ <br /> ~ ? <br /> ~ Project manager /contact /private engineer: /(P,~~ <br /> PROJECT SCOPE: R o S S <br /> j ' Paving: V ~hs~ /~~~?'1 Bike lanes /paths: <br /> /widlhJ <br /> Concrete walks: etbac /Curbside <br /> (/engthf (widfhJ <br /> Wastewater ~ Stormwater ~ <br /> ~ Landscaping <br /> ! Signal Street lights ROW required <br /> I~ New building construction Planning, other Remodel <br /> ~ FUNDING SOURCES: <br /> Gity Assessments Private Other department <br /> Account code <br /> * ' fed /State /County /FAA fixed) <br /> COI~VIMENTS /SPECIAL PROJECT INFO. /INTERDEPARTMENTAL WORK DESCRIPTION: <br /> . , <br /> ! <br /> I <br /> I <br /> ;Y ~ APPROVED: , <br /> ! <br /> ! Project Manager ~ Date ~ <br /> , <br /> ~ ~ <br /> i <br /> Principal Engineer Date <br /> ~ I Facilities Manager Date <br /> i ~ a~ <br /> City Engineer Date <br /> I <br /> ~ ~ FOR USE BY ADMINISTRATION ONLY <br /> ~ Capital Project No. 3 / ~ ~ ~ ~ ~ ACK i!~31 ~ Cl~ XXXsI ~ ~y <br /> GL Title <br /> f <br /> ~ Assigned Date (O~~/~ <br /> I <br /> <br /> ~ Accounting by Date <br /> ~ <br /> I' <br /> ATTACHMENTS: <br /> ? Budget Estimate ? Developer Agreement ? Engineer's Report On Improvement Petition <br /> <br /> I ~ ? SDC Budget Worksheet C~pgineering Agreement ? Engineering Service Work Request I <br /> !I ? City Engineer's Initiating Order ublic Improvement Permit Application ? Map <br /> ~ ? Request for Scoping Meeting j „ 2I O <br /> L!1 J ~ <br /> LNG 415 WHITE /Finance YELLOW /Administration File PINK /Engineering File GOLDENROD /Project Manager ?UL Y2004 <br /> I i <br /> <br />