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~ City of Eugene <br /> <br /> _ Pubtic Works <br /> Application for Public Improvement Permit Engineering <br /> /I 858 Pearl Street <br /> Job Number. _ <br /> IX Eugene, OR 97401 <br /> (541)682-5291 <br /> FAX: (541)682-5032 <br /> Contract No: <br /> i <br /> I by make application for a PUBLIC IMPROVEMENT PERMIT to= <br /> construct public improvements in the public way, as described below: <br /> Type of Impd'ovement: wastewater, storm drain R curb & gutter paving <br /> (paving, wastewater, stomtwater, street lights) <br /> i <br /> i <br /> Location: ):Cinsrow Avenue Marche Chase Drive <br /> (street or easement work is within or subdivision name) <br /> North (or east) limit: Kinsrow Avenue South (or west) limit: Garden Why <br /> in strict confom7ance with City of Eugene standard spec'rfications for public improvements (including current addenda), <br /> cbrtstruction plartjs approved by the city engineer or his represerrtatrve, the current edition of "Procedures for Privately Engineered <br /> Projects," the Eugene City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> the work. <br /> responsible for pEroviding a copy of this pe/~rmit to the contractor performing <br /> Contact Person (prim ~ ~ r1 T 1 ~~:lGti. ~ ~ ~ <br /> Si nature Mailing Address K/~ ~a J ~ ~~~~~~~~~-T ~c C <br /> 9 ` <br /> Print signat re h e p <br /> Date Phone ' ~ City /State /Zip ~ ~ ~ n f~- 1 <br /> 00 NOT WRITE BELOW THIS LJNE <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is hereby granted to applicant and applicant's contractor to perform the work stated above, in conformance with <br /> conditions listed above, below, and on the reverse side of this permit form. <br /> The permit shall'be void unless the work described herein is completed by: <br /> SPECIAL CONDVITIONS , <br /> APPROVED: Date: <br /> City Engineer <br /> Eng: 604 FEBRUARY 2002 <br /> White: OwnedDesigner Canary: Contractor Pink: Inspector <br /> <br />