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, <br /> City of Eugene <br /> ' Public Works <br /> Engineering <br /> ~pp[ica#ion for Public improvement Permf# <br /> 858 Pearl Street <br /> F~gene, OR 97401 <br /> Job Number. {541 } 682-529t <br /> FAX: {541 }662-5032 <br /> Garnract Na: <br /> i» ~ C7~'f hereby make application for a PUBLIC IMPROVEIUiEPIT PEHMR to <br /> t~~ <br /> cortsrtruct pubt~ imt~?roverrtertts in the public way, ss descziibed below: <br /> ~ o , <br /> Type of improvement: <br /> tpa+ripg, nraStAwBter, s6orntwatar, sweet tights) <br /> Locatian~ <br /> (6treet a ®agement wont is wi~in or wbdvis~on } <br /> htotih {or east} limit: South (orwest} emit: <br /> in strict conformance with City of Eugene standard specifications for public improvements Cnciuding current adder:da}, <br /> construction pions approved bytite ctty engineer otitis representative the curresntedition of "Procedures for Privately Engineered <br /> Projects," the Eugene City Code, and the standard and special conditions printed on this permit form. The owner/a~pticant is <br /> responsible for providing a copy of this permit to fine contractor performing the work <br /> Contact Person sv~,m u f 1 ` <br /> Signature Mailing Address ~~~t ~re-P~1 ~e t 0 /ty~ <br /> Print signatJ;~i+re iter <br /> Date _,~~~./c2~~L Phone S"~/ ' ~o~8`li6City /State /Zip d ~--.~4-~--E-- <br /> OQ NO7INRRE eEW W 'rHlS 4iNE <br /> PUBLIC tMPRQVEMENT PERMIT <br /> Permission is hereby granted to applicant and applicant`s contractor to perform the work stated above, in confonztance witfi / <br /> conditions Gsled above, below, end an the reverse side of this permit form. <br /> The permit shalt be void unless the work described herein is completed by: <br /> SPECIAL CONDf7idNS <br /> APFi'i4VE0: Date: <br /> City Engineer <br /> <br /> Eng: 604 <br /> 1Mtite: ownelnesigna canary. Cont~attw rinse Inspector <br /> <br />