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. <br /> City of Eugene <br /> Public Works <br /> \p lication for Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> .~ob Number: a _ -1 ~ Eugene, OR 97401 <br /> (541)682-5291 <br /> ,~i, FAX: (541)682-5032 <br /> ~ontract No: (Fr `,z~ <br /> ; ~ <br /> I r1 ! (~l~- (i f't i , ~ hereby malts application for a PUBLIC IMPROVEMENT PERMIT to <br /> tad <br /> onstruct public improvements in the public way, as described below: <br /> _ <br /> Type of Improvement: E i~1/il~-(('- i.~, 1~~.~4~:~ I~~.y- E- i (t!-_~- G~-f I <br /> (paving, wastewater, storrnwater, street lights) <br /> Location: ~ r 'I~.i ~ ~ 't't- ~ _ ~ t~'+`~ d..11 ~ 1 ` <br /> (street a easement work is within or subdivision name) <br /> ( ) . ~ c; ~ ~r South (or west) limit: ~ Y' ~ { ~ ~ <br /> North or east imit: i <br /> strict conformance with City of Eugene standard specifications for public improvements (including current addenda), <br /> onstruction plans approved by the cify engineer or his representative, the current edition of "Procedures for Privately Engineered <br /> rojects," the Euge~te City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> esponsible for prov~ding a copy of this permit to the contractor performing the work. <br /> i <br /> ~ontact Person ta~~¢ <br /> ~6ignature - Mailing Address ~,j f :i % a~, L~ <br /> rint signat re her' % ~w ~ .~_l ~ <br /> ate .Phone ~ <br /> ~ ~ ~ City /State /Zip . = . , , a f '"'cif' ~ f <br /> ~f~j' } J1 <br /> t <br /> 00 NOT WRrTE BELOW THIS LJME <br /> PUBLIC IMPROVEMENT PERMIT <br /> 'Permission is hereby granted to applicant and applicant's contractor to perform the work stated above, in confom?ance with <br /> conditions listed above, below, and on the reverse side of this permit form. <br /> r <br /> he permit shall be void unless the work described herein is completed by: ~ ~ ~ <br /> 'SPECIAL CONDITIONS <br /> n <br /> APPROVED: ~ a 1 r Date: ' 1~ A <br /> U ~-Fr' Engin r ' r-T-; r <br /> <br /> Ertg: j604 FEBRUARY 2002 <br /> Whfte: Owner/Designer Canary: Contractor Pink Inspector <br /> <br />