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t,, <br /> City of Eugene <br /> Public Works <br /> dpplication fo Public Improvement Permit Engineering <br /> A 858 Pearl Street <br /> Job Number: . ~ Eugene, OR 97401 <br /> (541) 682-5291 <br /> FAX: (541)682-5032 <br /> Contract No: <br /> !I, hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (owner) <br /> construct public im rovements in the public way, as described below: <br /> 9 <br /> i <br /> ~ Type of Impro ement: j ~ <br /> i <br /> (paving, wastewater, stomtwater, street lights) S~~~ ~ P j(~,,.t'~'~' <br /> ~ Lof 1r <br /> 1 <br /> Location: <br /> (street or easement work is within or subdivision name) <br /> w~ .4i1~ ~u~lr <br /> North (or east) limit: ~U- <br /> ~,~Q'~t'fT <br /> ~ <br /> l~~ South (or west) limit: T / <br /> ~k, <br /> Fn strict conforma ce with City of Eugene standard specifications for public improvements (including current addenda), <br /> construction plans pproved by the city engineer or 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 /> (responsible for pro iding a copy of this permit to the contractor performing the work. <br /> II'' ) ~ <br /> Contact Person (n~' Pc~~.t l f'!i qct ~~1Gle~ /t~ , L-~-G <br /> i <br /> I <br /> (Signature Mailing Address Dtl~ <br /> print signature her Q. <br /> pate ~ ~ Phone ( g 5" City /State / Zip r ~T~ ~ Q7 <br /> I DO NOT WRITE BELOW THIS LINE <br /> PUBLIC IMPROVEMENT PERMIT <br /> i permission is here y 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 void unless the work described herein is completed by: <br /> ESPECIAL CONDITI NS <br /> i <br /> I <br /> I <br /> ! ~4PPROVED: Date: <br /> ~ i City Engineer <br /> I <br /> <br /> Enp: 804 FEBRUARY 2002 <br /> I~ White: OwnedDesigner Canary: Contractor Pink: Inspector <br /> <br />