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OS?3 /'L006 V1')vll 15: Y4 NAX 541 62fY 5U3L t'll' ~nKineerinK LQJOp1~OQL <br /> J <br /> 111 <br /> City of Eugene <br /> Public Works <br /> ~lpptication or 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 /> hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> - (mod <br /> construct public improvements in the pub1lic way, as described below: l_ <br /> Type of Im rovement: a t T~ ~ i~~' ~ ~ I ~ek~.~ j~r~t,~e <br /> ~ ~ (pavan , wastewater, atormwater, street lights) <br /> ~ C1l~pLocation: ~ Z~C7 W 25~ ~ S <br /> ~ ~'1 (street or easement work is within or subdrvislon name) <br /> i <br /> j North (ore t) limit: ~P`j~ ~ ~ South (or west) limit: ~ ~ ' ~E <br /> in strict confo ante with City of Eugene standard specifications for public itnprovemertts (including current addenda), <br /> ~ construction p approved bythe city engineerorhls representative, the current edition of "Procedures forPrivately Engineered <br /> Projects " the E ene City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> II' responsible for roviding a copy of this permit to the contractor performing the work. <br /> If I <br /> ~ Contact Person M C ~ <br /> 3 <br /> Signature ( Mailing Address ~ ~-7 ~ 5 ~ 21 S <br /> Print si nature re ~ C ~ - ~ ~ ~~e 8-L <br /> ~ Date Phone ~ ~ 3 ~ 7 ZCity /State /Zip <br /> ~ ~.~5~3-,5'i`i -`7561 ~~'Zl~~ <br /> DO NOT WRITE BELOW TFUS ~ <br /> i <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is h reby granted to applicant and applicant's contractor to perform the work stated labove, in conformance whit <br /> ! ~ conditions listed above, below, and on the reverse side of this permit form. <br /> i ~ The permit shall be void unless the work described herein is completed by: <br /> I <br /> ~ SPECIAL CON ITIONS <br /> I <br /> I <br /> APPROVED: Date: <br /> City Engineer <br /> <br /> i <br /> Ehg:604 FEBRUARY 2002 <br /> Wfiite: Ownedpesipnar Canary: CorMraeWr Pink: Inspector i <br /> <br />