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. ~ <br /> City of Eugene <br /> Public Works <br /> 4ppiication for Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> Job Number. Eugene, OR 97401 <br /> (541)682-5291 <br /> FAX: (541)682-5032 <br /> Contract No: <br /> I, ~m Im~ ~ ~r~ <br /> hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> construct public improvements in the public way, as described below: <br /> Type of Improvement: ~~y I "JG ~ IrV Y~5 <br /> FEIN ~Zt~ ~"-[c~M~try?'~~iE. (Z ~ <br /> jQ~~ ~tG {{-15 V'fi ~~T? <br /> (paving, wastewater, stonnwater, street Nghts) <br /> Location: ~ i~C t'~ °[vS t-~ ? v l~--l~} U <br /> r~., (street or easement work Is wltMn a subdivision name) <br /> North r east limit: v ~-f r P~ k-- ~ <br /> ~ South r west) limit: N ~ Ex P ~ ~~''h <br /> in strict conformance with City of Eugene standard spec~ications for public improvements (including current addenda), <br /> 'construcction plans approved by the city engineer or his representative, the current edition of'Procedures for Privately Engineered <br /> Projects," the Eugene City Code, and the standard and special conditions printed on this permft form. The owner/applicant is <br /> responsible for providing copy of this permit to the contractor performing the work. <br /> Corrtact Person ~ <br /> ~ g <br /> Signature Mailin Address / ~0 <br /> Print s' to he 0 m ~r Q' 7 <br /> `Date ~ ~ Phone City /State /Zip ~ ~ 1 <br /> 0o rror wrurs eeww rrtrs rJNE <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is hereby granted to applicant and applicant's 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: Date: <br /> City Engineer <br /> <br /> Eng: 604 FEBRUARY 2002 <br /> VVFdte: OwnedDeaipner Canary: Contractor Pink: Inaperxor <br /> <br />