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iUi~La/LUU! Ue:le ran Ovl4eaaOL4 ruAl.,L' C.IV la 11V t',r,x11V 1, ~E/_IUUJ <br /> :z <br /> 4 <br /> City of Eugene <br /> r <br /> Pgbllc Works <br /> !,ppfica#ion for Public lmprovemen# Permit Engineering <br /> 856 Peed Street <br /> Job Number: % ~ / / Eugene, OR 97401 <br /> (541) 682-5291 <br /> FAX: (541) 6825032 <br /> ' Contract No: <br /> 1, / 7 ! ~J ~r~ S~ J~ hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (arneA <br /> I, construct public improvements in the public way, as described below: <br /> Type of Improvement <br /> (pa~Mg, wastewater, stprmwatar, sweet Ilgpts) <br /> Location: G / VI~~C'.~ ~ S j ~h- <br /> (Btroet aea~ement work la within or 5ub~vislon name) <br /> North (or east) limit: South (or west) limit: <br /> in strict conformance with City of Eugene standard specifications for public improvements (including current addenda), <br /> constnrction plans approved by the dty engineer or his representative, the current edition of "Procedures for Privately Engineered <br /> ~ Prv~ects," the Eugene Clty Code, and the standard and special condt6ons printed on this permit form. The owner/applicant is <br /> ~ nsponsible for providing a cagy of this permit to the contractor performing the work. <br /> Contact Person (pau) p'11 <br /> signature ~ ~ MaiNng Address ~~3 ZZ~_Z_( <br /> ' Print signature here ~ ' ~ ~ ~ <br /> Date - Z Phone - ~ City /State / zp ~ ~ ~ ~ ~ 74~ Z <br /> po reo'r wrert~ afcow ~ LHIE <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is hereby granted to applicant and applicant's contractor to perform the work stated above, in confvrmance with <br /> condftlons 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 try: <br /> SPECIAL CONDITIONS <br /> APPROVED• Date' ~ ~ ~ <br /> City Engines <br /> <br /> EAg: 604 FEBRUARY 20Q? <br /> Whk": Owned0esFpner Cgnn.y. Centre~mr Pink Irmpernor <br /> 05/29/2007 TtiE 9:29 (JOB N0. 9227) f~003 <br /> <br />