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City of Eugene <br /> Public Works <br /> <br /> A plication fdr Public Improvement Permit Engineering <br /> 22 858 Pearl Street <br /> Job Number. ~ ~ J ~ Eugene, OR 97401 <br /> (541) 682-5291 <br /> FAX: (541)682-5032 <br /> Contract No: <br /> 1, Dean Schmidt 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 wastewater, storrnwater* strPPr 1 i ghr <br /> (paving, wastewater, stortnwater, street lights) <br /> Location: L ne Oak Subdivision <br /> (street or easement work is within or subdivision name) <br /> III <br /> North (or eask) limit: South (or west) limit: <br /> in strict conformance with City of Eugene standard specifications for public improvements (including current addenda), <br /> construction plans approved by the city engineer or his represerttative,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 permit to the contractor performing the work. <br /> Contact Person (pari~i -~L= ~ C ~ L/7 / <br /> Si nature ~ Mailing Address 2941 Edgewater Urive <br /> 9 <br /> Print signature h re )ean ~chmi tit <br /> Date ' Phone. 541-501-1151 Ciiy /State /Zip Eugene, OR 97401 <br /> no troT wrtrr>: eet,.ow Tt~tts arts <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is he eby granted to applicant and applicant's contractor to perform the work stated above, in conformance with <br /> conditions listed ove, below, and on the reverse side of this permit form. <br /> The permit shall void unless the work described herein is completed by: <br /> i <br /> SPECIAL CONDITIONS <br /> APPROVED: Date: <br /> City Engineer <br /> i <br /> i <br /> Eng 604 FEBRUARY 21702 <br /> White: pwngdpesigner Canary. Contractor Pink Inspector <br /> <br />