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'.-t' <br /> <br /> ~ City of Eugene <br /> Public Works <br /> Application for Public Improvement Permit Engineering <br /> j 858 Pearl Street <br /> i Job Number. 2~5 _ Eugene, OR 97401 <br /> (541)682-5291 <br /> FAX: (541)682-5032 <br /> Contract No: <br /> I <br /> 1, Arlie ix Company hereby make application for a PUBLIC IMPROVEMENT PERMIT for <br /> can <br /> construct public improvements in the public way, as described below: <br /> l Paving, wastewater, stormwater, street lights <br /> Type of Improvement: <br /> (paving, wastewater, stormwater, street Gghfs) <br /> C r~r.~ccn-l- Vi l ~ Qge <br /> Location: Lord Byron Place- Phase ~ 3~C} <br /> (street or easement work is within or subdivision name) <br /> North (or east) limit: South (or west) limit: Lord Byron Place -Phase 3 <br /> in strict conformance with City of Eugene standard specifications for public improvements (including current addenda), <br /> construction plans approved bythe city engineer or his representative, 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 /> responsible for providing a copy of this perrnit to the contractor performing the work. <br /> Contact Person tp~~, NI k i~1i- ' s <br /> Signature Mailing Address 871 Country Club Rd. <br /> Print sig at re here ~~-f~ M' <br /> Date 2 Phone 31iLs-55L1n City/State /Zip Eugene, OR 97401 <br /> no r+or warrE eFlow T?as t~ <br /> PUBLIC IMPROVEMENIT PERMIT <br /> Permission is hereby granted to applicant and applicant's contractor to perform the work stated above, in conformance with <br /> i conditions listed above, below, and on the reverse side of this permit form. <br /> i <br /> The permit shall be void unless the work described herein is completed by: <br /> SPECIAL CONDITIONS <br /> i <br /> I <br /> APPROVED: Date: <br /> City Engineer <br /> Eng: 604 FEBRUARY 2002 <br /> White: OwnedDesigner Canary. Contractor Pink Inspector <br /> <br />