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~'ir <br /> City of Eugene <br /> Public Works <br /> application #or Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> Job Number. ~ 1 Eugene, OR 97401 <br /> (541)682-5291 <br /> FAX: (541) 682-5032 <br /> Contract No: <br /> 1, Jack Adkins hereby make application for a PUBLIC IMPROVEMENT PERMIT to; <br /> (owner) <br /> construct public improvements in the public way, as described below: <br /> Type of Improvement: Paving, Curb, Sidewalk, Street Light, Storm & Wastewater <br /> ~ 1t~9. wastevrater, stormwater, street lights) <br /> Location: Meadow Butte <br /> (street or easement work is within or subdivision name) <br /> North (or east) limit: South (or west) limit: <br /> in strict conformance with City of Eugene standard specifications for public improvements (including current addenda), <br /> construction plank approved bythe city engineer or his represerrtative,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 pt!oviding a copy of this permit to the contractor performing the work. <br /> ..~-~'r . <br /> Contact Person canMi Scott Goebel <br /> Signature Mailing Address 1762 West 2nd Avenue <br /> j Print signature hire ~ccstC ~~ti36i~n, <br /> Date _ ~r3-o~ Phone (541) 687-0542 City /State /Zip Eugene, Oregon 97402 <br /> DO NOT WRITE BELOW THIS LINE <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is hereby granted to applicant and applicants 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 bie void unless the work described herein is completed by: <br /> SPECIAL CONDITIONS <br /> APPROVED: Date: <br /> City Engineer <br /> i <br /> <br /> Eqg: t~04 FEBRUARY 2002 <br /> VYhite: QiwneNDesigner Canary, Contractor Pink Inspector <br /> <br />