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. <br /> ' ~ City of Eugene <br /> Public Works <br /> Aj lication fo Public Improvement Permit Engineering <br /> p 858 Pearl Street <br /> Eugene, OR 97401 <br /> <br /> li Job Number: (541) 682-5291 <br /> FAX: (541)682-5032 <br /> !Contract No: <br /> <br /> i <br /> I 1, z ns tru~ <br /> ~ ion Com an hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> construct public im rovements in the public way, as described below: <br /> j <br /> I ~ Type of Impro ement: Pavina Curbs, Wastewater and Stormwater System <br /> ~ j (paving, wastewater, sronnwater, street lights) <br /> I <br /> ~ Location: E st Rid a Villa a P.U.D. Oakfern Road <br /> (street or easement work is within or subdivision name) <br /> I <br /> ~ Laurel Hill Drive <br /> j North (or eas) limit: Rra rkenf ern (Future) south (or west) limit: <br /> it <br /> a! <br /> in strict conform nce with City of Eugene standard specifications for public improvements (including current addenda), <br /> construction plan approved by the city engineer or his representative, the current edition of "Procedures for Privately Engineered <br /> Projects," the Eu ene City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> 'responsible for pr viding a copy of this permit to the contractor performing the work. <br /> 1 Contact Person ~ Nanc J . Wi 11 i ams , ~ ~1R i q <br /> 1~~ ~ <br /> Euq eine , <br /> Signat a ~1 Mailing Address ~bf$-~-" ~ ~ ~ Dv'-"' <br /> Print i at re h re N~'~~~° LV~LL Y 3tri-±~ <br /> ~T <br /> ~ ~ Date ~ r c Phone ~ 3 Z t City /State /Zip g9 ~ BPS <br /> DO NOT WRITE BELOW THIS UNE <br /> PUBLIC IMPROVEMENT PERMIT <br /> J <br /> Permission is hel eby granted to applicant and applicant's contractor to perform the work stated above, in conformance with <br /> conditions listed ove, 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 CON TIONS <br /> { j <br /> APPROVED: Date: <br /> City Engineer <br /> Eng: 604 FEBRUARY 2002 <br /> White: OwnedDesigner Canary: Contractor Pink: Inspector <br /> <br />