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City of Eugene <br /> Public Works <br /> Application for Public Improvement Permit Engineering <br /> ' 858 Pearl Street <br /> Jpb Number: cJ ~ _ Eugene, OR 97401 <br /> (541) 682-5291 <br /> FAX: (541)682-5032 <br /> Contract No: <br /> ~ I LEN E N ~C.E N hereby make application for a PUBLIC IMPROVEMENT PERMIT to r <br /> (owner) <br /> cgnstruct public imp vements in the public way, as described below: <br /> Type of Improv ment: n~y 1 N G. W 14S-~CW *T~ rL., ~~.~VY~'E'lEK-. , 5'~'~t,CE~ ~ lG1}T,S <br /> (paving, wastewater, stonnwater, street lights) <br /> i <br /> Location: ~ ~ ~ t LC l L L Lf~4~ <br /> j (street or easement work is within or subdivision name) <br /> _ ort (or east) li it:Jrl~~-~- ~ w out or <br /> n~limit: ~~l LE~ ~r ~ ~ ~~fl <br /> ir1 strict conforman with City of Eugene standard speC'Ifications for public improvements (including current addenda), <br /> c nstruction plans roved bythe city engineer or his representative,the current edition of "Procedures for Privately Engineered <br /> jests," the Eugen City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> r sponsible for provi in a copy of this permit to the contractor performing the ,wo~rk? <br /> ~ ~ O N flr ,Y~ <br /> Contact Person (pdr~j ~ ~ J <br /> 1 j <br /> S gnature Mailing Address Z ~ Z 7 <br /> Pint sign ure ere <br /> Date Phone ~ ~~os City /State /Zip ~Z <br /> a <br /> DO NOT WRRE BELOW THIS UNE <br /> PUBLIC IMPROVEMENT PERMIT <br /> P rmission is hereb granted to applicant and applicants contractor to perform the work stated above, in conformance with <br /> c ndfions listed abo e, below, and on the reverse side of this permit form. <br /> T~te permit shall be v id unless the work described herein is completed by: <br /> S~ECIAL CONDITI S <br /> A~PROVED: Date: <br /> City Engineer <br /> <br /> Eng: 604 ~ FEBRUARY 2002 <br /> White: Owner/Designer Canary. Contractor Pink Inspector <br /> <br />