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. ~ y <br /> City of Eugene <br /> Public Works <br /> 4~plication 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 /> j Contract No: <br /> i <br /> I, ~ ~ ~ ~~G ~ hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (mod <br /> 'construct public improvements in the public way, as described below: J <br /> Type of Improvement: ~ n~ t.?~ s 7~e-,,?~ ~y' S ~ r,?.~ W~.If-ti- s ~f ~ ~i1Y <br /> (paving, wastewater, stommrater, street lights) <br /> 1"?vf0 c L J <br /> ~ LOCatIOn: ~~r o' 4 i1 ~~J~. / l G ti ~ J V •J Gt l lOl s ! 0.1 CSC f75^ <br /> (street or easement work is within or aubdMsion name) <br /> F_~. s ~ o v,, oI c r ~ d F CJz > f c~c~.,-~• t+ <br /> North (o east imit: ai' 2od South (o~limit: ~o f <br /> /~'t~o / -t3- 2~ ry~P ! ~ - p - r3 - Z~- <br /> to strict conformance with City of Eugene standard specifications for public improvements (including current addenda), <br /> ~constniction plans approved by the city engineer or his representative, the current edition of "Procedures for Privately Engineered <br /> 'y projects," the Eugene City Code, and the standard and special conditions printed on this permit fore. The owner/applicant is <br /> responsible for providing a copy of this permit to the contractor performing the work. <br /> Contact Person(v~n0 I/~~ ~ /~Gi~,SP~- ~~~c~~e ~~f" . <br /> Signature ~ Mailing Address ~ ~ ~ Z'~ Z 7 <br /> print signature here /~~~e~tGe ( 3: i~'G, s.1- <br /> pate ! <br /> 2-T <br /> f <br /> ~ ~ Phone ~'S ~ S t? S City /State /Zip ~u ct e- ~ ~ 1 ~ ~ ~t? 1_ <br /> j, <br /> DO NOT VYRme BELOW TNIS LINE <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission Is hereby granted to applicant and applicants contractor to perforn the work stated above, in conformance with <br /> conditions listed above, below, and on the reverse side of this permit form. <br /> j The permit shall be void unless the work described herein is completed by: <br /> SPECIAL CONDITIONS <br /> i APPROVED: Date: <br /> City Engineer <br /> <br /> Eng; 604 FEBRUARY 20x2 <br /> VVFdte: OwnedDesipner Canary. Contractor Prole Inspector <br /> <br />