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t, 't <br /> City of Eugene <br /> Public Works <br /> A placation for Public Improvement Permit Engineering <br /> 1 ~ 858 Pearl Street <br /> Job Number: / Eugene, OR 97401 <br /> I <br /> (541) 682-5291 <br /> Contract No: FAX: (541) 682-5032 <br /> 1, v ~~~~-A-~~ hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> colhstruct public improvements in the public way, as described below: <br /> Type of Improvement: Irtr?~gp~l~E~?'~ <br /> (paving, wastewater, stormwater, street lights) <br /> Location: 'T~~' ~~TI_~T <br /> ,[P~1"~~~11t~~ <br /> (street or easement work Is within or subdivision name) <br /> North (or east) limit: N_D~ ~PTZ(11'Ei2T~l LI iftifE South (or west) limit: 1J41e1i; <br /> ~ in strict conformance 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 edition of "Procedures for Privately Engineered <br /> j Proyects," the Eugene City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> E responsible for providing a copy of this permit to the contractor performing the work. <br /> i <br /> !Contact Perso ,>n A mG-S ~ <br /> ' i `i~ i~ <br /> Signature Mailing Address ~ I d5 Cat l.E.~~ <br /> ~f i Print si ure here <br /> Date Phone.~1~V~~N(I~ City/State /Zip~d~ OQ ~~~OZ <br /> i i <br /> I <br /> DO NOT WRITE BELOW TNIS LINE <br /> i <br /> PUBLIC IMPROVEMENT PERMIT <br /> 1 <br /> Permission is hereby granted to applicant and applicant's contractor to perform the work stated above, in conformance with <br /> i .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 /> I <br /> I <br /> jAPPROVED: Date: <br /> ~ City Engineer <br /> I <br /> <br /> Eng: 6p4 FEBRUARY 2002 <br /> Whke: OwnedDesigner Canary: Contractor Pink: Inspector <br /> <br />