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' ~ <br /> City of Eugene <br /> Public Works <br /> ~?pplication for Public Improvement Permit Engineering <br /> ' i , 858 Pearl Street <br /> ;Job Number: y Eugene, OR 97401 <br /> (541) 682-5291 <br /> FAX: (541)682-5032 <br /> Contract No: ' <br /> ~ I, hereby make application for a PUBLIC IMPROVEMENT PERMIT to. <br /> (owner) <br /> construct public improvements in the public way, as described below: <br /> 1 <br /> ~E Type of Improvement: J 4nJ ! r ~ JG'' 1~ ~ r /~1~~ i~~~C~s/ 1? /1~ <br /> I (pevN+p, wastewater, ibrrnwatsr, street tights) <br /> 1 'c C e <br /> yt Location: rCl' I 1 E ~ 1. J ~ L ~/~'11 /'"~i ~U <br /> (street or easement work is wNhM or sutxtlvkton name) <br /> i , <br /> ~ North {or east) limit: ~ 1 ~ Sauth (or west) limit: <br /> in strict conformance with City of Eugene standard specffic~tions for public improvements (including current addenda), <br /> constriction plans approved by the city engineer or his represerttative,tha current edition of "Procedures for Privately Engineered <br /> Prgjects,' the Eugene City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> responsible for providing a copy of this permit to the oontracDor performing the work. <br /> Cor><act Person cwhq ~ ~e 11 ~ ~ 7 ~ /~K / ~-s <br /> QC~, fox ~ 7 7 ~r~:v ~ <br /> Signature Mailing Address <br /> Print sig^natuj~ here ~ / ~Q <br /> Date ~L' O 7 ,Phone ~ S 'S 'nCity /state /zip Or / K~1 ©y`. ~7 d_~ <br /> So3-3r7-y~i ~ <br /> i DO NOT WRnE BELOW itNS LktE <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission k hereby granted to applicant and applicants contractor to perform the work stated above, in conformance with <br /> conditions listed above, below, and on the rr3verse side of this permit form. <br /> i <br /> The permft shall be void unless the work described herein is completed by. <br /> SPECIAL CONDITIONS <br /> i <br /> I APPROVED: Date: <br /> City Engineer <br /> I <br /> <br /> Eng: 604 FEBRUARY 2002 <br /> NTge: Ownsr/Desipnar taroiy. Coraracta Peck Mapactor , <br /> <br />