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~ . <br /> City of Eugene <br /> Public Works <br /> Application 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, L i~~OP r~ hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> jconstruct public improvements in the public way, as described below: <br /> Type of Improvement: ~1 ~~i ~7N~1, ~/'rVn)Q~~~Q~S~- ~e~ <br /> (paving, wastewater, storrnwater, street lights) <br /> ~ Location: ~ <br /> (street or easement work Is witltin or subdviston ame) <br /> North (or east) limit: South (or west) limit: <br /> in strict conformance with Ciiy of Eugene standard specificatlons for public improvements (including current addenda), <br /> construction 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 permit form. The owner/applicant is <br /> responsible for providing a copy of this permit to the contractor performing the work. <br /> Svi- 9'8S Z <br /> Cortitact Person Iv~o IaPA ~OWeI~ y$•4 ~~n ~/'OI,tA, ~s~ 9~y-~i <br /> i~ , <br /> ;Signature Mailing Address f <br /> Print signs ure ere ~?P/) p <br /> ,Date 3 7 Phone City /State /Zip ,~t/l/ G-'/y t~_. ~!L- <br /> DO NOT WRRE BELOW THIS LN9E <br /> I <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is hereby granted to applicant and applicants contractor to perform the work stated above, in conformance with <br /> i !conditions listed above, below, and on the reverse side of this permft form. <br /> iThe pemtft shall be void unless the work described herein is completed by: <br /> ESPECIAL CONDITIONS <br /> ' (APPROVED: Date: <br /> City Engineer <br /> <br /> Eng: 604 FEBRUARY 2042 <br /> WMIe: OwnerlDssipner Canary: Contractor Pink Inspector <br /> <br />