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~ -''`s <br /> ~ <br /> t <br /> C'Ity of Eugene <br /> Public Works <br /> 4p I~cation for Public Improvement Permit Engineering <br /> [f <br /> / ~ 858 Pearl Street <br /> glob Number: 7 '7 Eugene, OR 97401 <br /> (541)682-5291 <br /> FAX: (541)682-5032 <br /> contract No: <br /> I' <br /> 3o{.n N, P~~~Sor1 hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> tad <br /> bonstruct public improvements in the public way, as descAribed below: <br /> Type of Improvement: ~ K~~ ~ru.~`l~i~ ~ ~a.~~?1 ti ; S ~v1 ~ ~ uJ' ~ S awl <br /> (paving, wastewater, s~rmvvater, street Hghta) <br /> Location: ~ ~ ~ ~ ~ US Q- E S~-o~`~ e S <br /> (street or easement work Is within or aubdvislon name) <br /> North (or east) limit: k ~"m'''~ South (or west) limit: <br /> in strict coMormance with City of Eugene standard specifications for public improvements (including current addenda), <br /> construction plans approved by the city engineer or his representative, the current edidon of "Procedures for Privately Engineered <br /> j Ptojeots'the Eugene City Code, and the standard and special conditions printed on this permft form. The owner/applicant is <br /> rt~sponsible for providing a copy of this permit to the contractor performing the work. <br /> i <br /> Clontact Perso 1v~4 <br /> Signature Mailing Address <br /> Paint Signatu here <br /> j Gate ~ Phone City /State /Zip <br /> 0o rror wrurE eFaow rras urn <br /> r.. <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is hereby granted #o applicant and applicants contractor to pertorm the work stated above, in conformance with <br /> aondltions 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 /> Dp; 604 FEaAUnar 2na2 <br /> whke: tlOsaipner canary: Conasaor Pink Irupecror <br /> <br />