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r <br /> <br /> ` City of Eugene <br /> Public Works <br /> pplication f r 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, ~ / ~ ~ ~ - hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> /l1 ~G T Na+~! <br /> construct public emerrts in the public way, as describe-deb-el-ow: <br /> Type of Im merit: /C`~f"~ ~/I~f I~1~~~N/~ . <br /> (PavhW, wastewater, ctormwater, street <br /> Location: ~ j~ <br /> (str/eet/or easement work is wIR>irt or subdrvlslon Hems) j~ <br /> North (or eas) limit: l~ ~Q ~ ~ ~ y till South (or west) limit: G ~/~L/ <br /> in strict oonfo with City of Eugene standard sper~frcations for public improvements (including current addenda), <br /> ~ fiction pla approved bythe dty engineeror his representative, the current edition of procedures for Privately Engineered <br /> Projects " the E ne City Code, and the standard and speaal conditions printed on this permit form. The owner/applicant is <br /> responsible for p ' ing a copy of this permit to the contractor performing the work <br /> ~I~ . <br /> contact Person t~xA' .11i,11f _ <br /> GJy~'/ > ~ <br /> Signature Mailing Address JUy~~fG~'~. 1~ ~/IfJ~ ~J~ <br /> Print signature he <br /> Date Phone ~ 79 City /State / Zp ~/<TG13/lJ UlC ~~o~~~ <br /> i <br /> i <br /> 0o aor rrrvn: err ras ut~ <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is he granted to applicwrtt and applicant's corttrador to perform the work stated above, in. conformance with <br /> i ;conditions fisted e, below, and on the reverse side of this permit form. <br /> The permit shall void unless the work described herein is completed by: <br /> SPECIAL COND ONS <br /> i <br /> i <br /> I <br /> ~ APPROVED: Date: <br /> City Engineer , <br /> i <br /> i <br /> Erie: 604 FEBRUARY 2002 <br /> Whge: OwroNDeaipner Cansrtr. Contractor Pink: k~saor <br /> <br />