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s. E! . ~ ~,,r.r~{„q, s;:"--• t N o-q,~~sf""R"gs!P,' r.vTa-yn,r'f,!'~.~., <br /> a <br /> Engineering <br /> PROJECT NUMBER REQUEST ~ Public Works <br /> 58 Pb`a IgStreet <br /> ' ~ ~ x ~ ~ ~ ~ t, ~ r Eugene, OR 97401 <br /> I i~ ~ G (503) 687-5291 <br /> Job No. ~ ~ <br /> I <br /> Project title: ~ t!"Z-G I`3 N~'( ~S T ~A 1 L <br /> (location and wodt de <br /> \urlption) p J, t y F t <br /> , ~ fry ~ 1 ~ r { LG, y'h i, ...t `t", ~~i Vl t~ Y~ ~i'~' . 1/i Ci ~ i G~~ ~t Q t Y r ~ G ~~r .rr~ t'L k ~6 t i t ~Y„ . <br /> Project manager /contact /private engineer: ~~~~zzi^~-~/~ a l 7 t' f~ r ~ ~1 <br /> I ~ <br /> PROJECT SCOPE: <br /> Paving: h~~ ° _ Bike lanes /paths: <br /> (widths) (width) <br /> Concrete walks: Setback /Curbside <br /> (length) (width) <br /> j Sanitary sewer Storm sewer Landscaping <br /> j Signal ~ Street lights ROW required , <br /> I' <br /> New building construction Planning, other ~ ~ ~ Y~ I ~ Remodel <br /> FUNDING SOURCES: <br /> ~ City Assessments Private Other department <br /> Fed /State /County /FAA fixed) <br /> I <br /> COMMENTS /SPECIAL PROJECT INFO. /INTERDEPARTMENTAL WORK DI=SCRIPTION: <br /> _ <br /> y" dA0 iC~ r ~ <br /> r ~ . k.. t+ ~ t # y ct r i ` ~ ~ p ~ r` - s ; . 5 ~ " t %.e , <br /> i ( d <br /> <;t~.; iF' Y";Yl~~%Y~j7Yf~ Gu, te~p{YiZ1 ~ 4~ t ~fI +G'Ihd..l'KS / > ctr' c'.rarYs~~i. <br /> A e Y c -Y -~1 t, _ <br /> r~ <br /> i <br /> ~ ; <br /> i <br /> f <br /> Prbje``c Hager ` ` ; C;~ - - 1 Date ~ l3 ~ <br /> ~ ~ Principal Engineer - Date ~ ~ <br /> Facilities Manage~"~ Date <br /> /~~7~#[J' C j~ r'` ~ Date ..7 c=- <br /> I <br /> J <br /> FOR USE BY ADMINISTRATION ONLY <br /> Capital Project No. <br /> i <br /> GL Title ~ti`l 2 ~ acs it i~ C~ i"~'~ ta, ti , <br /> j Assigned b~~~ <br /> ~`~~1-r~~~' Date ~ <br /> Accounting by Date <br /> i <br /> ATTACHMENTS: <br /> ~7 Budget Estimate ? Developer Agreement ? Engineer's Report On Improvement Petition <br /> ' ? Engineering Agreement ? Engineering Services Work Request ~l Map <br /> <br /> I ? City Engineer's Initiating Order ? Public Improvement Permit Application <br /> I <br /> I <br /> 2i9t WHITE /Finance YELLOW /Administration File PINK! Engineering File GOLDENROD /Project Manager <br /> t a <br /> I <br /> <br />