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i <br /> ,ti <br /> City of Eugene <br /> Public Works <br /> 4pplication folr 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 Tom 4J lter hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (owner) <br /> ,construct public im rovements in the public way, as described below: <br /> I <br /> Type oflmpro ement: paving, wastewater, stormwater, street lights <br /> (paving, wastewater, stormwater, street lights) <br /> Location: Delta Meadow Subdivision <br /> li (street or easement work is within or subdivision name) <br /> North (or east limit: South (or west) limit: <br /> in strict conforma ce with City of Eugene standard specifications for public improvements (including current addenda), <br /> construction plans pproved by the city engineer or his representative, the current edition of "Procedures for Privately Engineered <br /> Projects," the Eug ne City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> responsible for pro iding a copy of this permit to the contractor performing the work. <br /> Contact Person (p~ ~ A Tom LJa l t e r <br /> Signature ~ Mailing Address 2863 Riverz~ralk Lp . <br /> Print signat re he ~ s ~ - ~ <br /> Date ~ L Phone 683-6355 City/State/Zip Eugene, OR 97401 <br /> ~I <br /> DO NOT WRfTE BELOW THIS LINE <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is her y granted to applicant and applicant's contractor to perform the work stated above, in conformance with <br /> conditions listed a ove, below, and on the reverse side of this permit form. <br /> i <br /> ',The permit shall b~ void unless the work described herein is completed by: <br /> SPECIAL CONDII~IONS <br /> APPROVED: Date: <br /> City Engineer <br /> <br /> Eng: 604 FEBRUARY 2002 <br /> White: Owner/Designer Canary: Contractor Pink: Inspector <br /> <br />