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City of Eugene <br /> Public Works <br /> <br /> lpplication for Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> Job Number. _ L 7 Eugene, OR 97401 <br /> ~ (541)682-5291 <br /> FAX: (541)682-5032 <br /> ~Co-nit-rac-t~No: <br /> I, J L L~-55 E ?~-s hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> lamed <br /> onstruct public improvements in the public way, as described below: <br /> Type of Improvement: P~u "y G . W t'!5'Z CV.I M4 iUL.. ~ l o r2t~ w ~4Z tr.2 <br /> i; (paving, wastewater, stormwater, street lights) <br /> Location: ~ ~.N ~5"T'~4 I E <br /> (street or easement work is within or subtfivision name) <br /> North r east) limit:~~~~ G South ( west) it: ~ • <br /> n strict corrfomtartce with City of Eugene standard specifications for public improvements (including current addenda), <br /> onstruction plans approved by the dty engineer or his represerrtative,the current edition of "Procedures for Privately Engineered <br /> rojects," the Eugene City Code, and the standard and special conditions printed on this permit forrn. The owner/applicant is <br /> esponsible for providing a copy of this permit to the contractor performing the work. <br /> j ~ontact Person Iprrnq ~j t.-- <br /> ~ignature Mailing Address Z S ~1 S j~/-~~I~~..~~ <br /> rintsignature he <br /> ate ~~,b ~ Phone ~ City /State /Zip ~ <br /> / 7/rri <br /> DO NOT WRRE BELOW THIS LINE <br /> PUBLIC IMPROVEMENT PERMIT <br /> ~ennission is hereby granted to applicant and applicants 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 /> ~-tte permit shall be void unless the work described herein is completed by: <br /> ~PECIAL CONDITIONS <br /> APPROVED: Date: <br /> City Engineer <br /> 604 FEBRUARY 2002 <br /> White: OwnedDesipner Canary. Comracxor Pink Inspector <br /> <br />