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City of Eugene <br /> Public Works <br /> 4~pplication for Public Improvement Permit Engineering <br /> ,Job Number. Eugenea OR 97401 <br /> (541) 682-5291 <br /> Contract No: FAX: (541) 682-5032 <br /> II I Z~lle word ,r?P~I~/' (,~,5 ~n Cd,,~pun~,ereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> Construct public improvements in the public way, as described below: <br /> type of Improvement: r f ~S ~ ~r -~S 5;de~ ~S <br /> (paving, wastewater, atorrnwater, street lights) <br /> Location: ~QW~r10+'!IP LS~Grl'S .Z /fG(G/~~7Y0~ <br /> (street or easement work Is within or sut>dlvlelon name) <br /> North (or east) Ilmit: ~IJL,tTI1 I~ ~ r ~ S~aTP'S Pit. ~ South (or eat limit: Sri m+~?'IP~ ~~„C ~'u?PS <br /> in strict conformance with City of Eugene standard specifications for public improvements (Including current addenda), <br /> construction plans approved bythe city engineeror his representative, the current edition of "Procedures for Privately Engineered <br /> Projects," the Eugene Clty Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> rAsponsible for providing a copy of this permit to the contractor performing the work. <br /> Contact Person cw?~A ~~t°I/P u/a r(r <br /> Signature Mailing Address f , 6 ~X ~ ~ ~ <br /> e si~,nature hereo Phon~~~~ J J City /State / ZI F 7 <br /> P <br /> oo Nor wtare setow T?tls uNe <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is hereby granted to applicant and applicants contractor to perform the work stated above, in conformance with <br /> ct>nditlons listed above, below, and on the reverse side of this permR form. <br /> The permit shall be void unless the work described herein is completed by: <br /> SPECIAL CONDITIONS <br /> AI~PROVED: Date: <br /> City Engineer <br /> <br /> Eng: 804 FEBRUARY 20Q2 <br /> Whits: OwnsHDedpner Ctnsry: CorMt~otor Pirdc Impactor <br /> <br />