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~ 1. <br /> City of Eugene <br /> Public Works <br /> Application for Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> Jpb Number: Eugene, OR 97401 <br /> (541) 682-5291 <br /> i <br /> j Contract No: FAX: (541) 682-5032 <br /> I, Jeff 1~'J 1 on- Cr~ar°les hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (owner) <br /> construct public imp vements in the public way, as described below: <br /> Type oflmprov ment: h'2.stewater Extension <br /> (paving, wastewater, stonnwater, street lights) <br /> I i <br /> I <br /> r <br /> Location: Hill Street near 3rd kvenue <br /> ~ (street or easement work is within or subdivision name) <br /> North (oreast) Imit: ?rd. P.venue South (or west) limit: ~Ve,1ue aZle~T <br /> ~ irh strict conforman a with City of Eugene standard specifications for public improvements (including current addenda), <br /> ~ nstruction plans a proved by the city engineeror his representative, the current edition of "Procedures for Privately Engineered <br /> rojects," the Euge a City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> 1 rrrsponsible for prov ing a copy of this permit to the contractor performing the work. <br /> ¢ontactPersoncpr;nn Jeff' tiJilson--Charles <br /> 1 <br /> Signature ~ G ~ ~ Mailing Address ~ ~ ~ ~ 5 ` ~''~I~ <br /> f~rint signature he e " ' ~Nf l?50 -L'~~5 <br /> gate ~ O 0 Phone ~ ~4' City /State /Zip Y ~~T~ L' ~ <br /> 1 <br /> ~ DO NOT WRfTE BELOW THIS LINE <br /> PUBLIC IMPROVEMENT PERMIT <br /> ermission is here granted to applicant and applicant's contractor to perform the work stated above, in conformance with <br /> conditions listed ab ve, below, and on the reverse side of this permit form. <br /> the permit shall be old unless the work described herein is completed by: <br /> I <br /> ~PECIAL CONDITI NS <br /> ~PPROVED: Date: <br /> City Engineer <br /> <br /> Eng: 6D4 FEBRUARY 2002 <br /> i WhRe: Owner/Designer Canary: Contractor Pink: Inspector <br /> <br />