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<br />Application for Public Improvement Permit <br />City of Eugene <br />Public Works <br />Engineering <br />dob Number. ~~C~ <br />Contract No: <br />858 Pearl Street <br />Eugene, OR 97401 <br />(541)682-5291 <br />FAX: (541) 682-5032 <br />I, ~"``~~~ ~-- • -~~h ~~. • ~ hereby make application for a PUBLIC IMPROVEMENT PERMff to <br />l~+uf <br />constnrd public improvemerrts in the public way, as described below: <br />~rype of Improvemetrt: `~C~Jn'sL' S}r~~~'/G~1- b~-b~,C. ~ ~ta.~ ~ E <br />'`~ (pavk~p, wastewater, stormwater, street Gphts) <br />-LQts <br />~Location• ~d~ '~~ ~ ~S ~ v i9 d.~ /r5 i v vi <br />(street a easement wnrtc k rMtlwn tx subdivision name) <br />North (or east) Nmit: South (or west) limit: <br />in strict oonfamtanoe with City of Eugene standard specifications for public hrtprovements (including current addenda), <br />constnretion plans approved bythe dty engint#eror his representative, the current edi8on of `Procedures for Privately Engineered <br />Prrojects,' the Eugene Cily Code, and the standard and spedal 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 />Corrtact Person ~- ~ eb <br />Signffiure <br />Print signature here ~ ~ cz. <br />Date ti- i7' 2oa L Phone 5yt -7N7-Z8 Fa (v <br />Matting Address 3711 S.Zi`'t~~9 ~'r N ~~~ ~ <br />city /state / zp -~l ~r~u~~ Jf; ll O,Q . X17 y S"~ <br />0o rror wnrrE stcow r+ns t~ <br />PUBLIC IMPROVEMENT PERMIT <br />Pernission is hereby granted to applicant and applicant's contractor to perform the work stated above, in. conformance with <br />conditions fisted above, below, and on the reverse side of this permit form. <br />The parnit shall be void unless the work described herein is completed by: <br />SPECIAL CONDITIONS <br />APPROVED: Date: <br />City Engineer <br />Enp: ~ ~ FEBRUARY 2042 <br />Whke:Orrt,sdgealpner CansrY Corwaetor Pink: Inspector <br />