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,,r.. <br /> . <br /> City of Eugene <br /> Public Works <br /> pplication fo Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> Eu ens, OR 97401 <br /> Job Number. 9 <br /> (541)682-5291 <br /> FAX: (541)682-5032 <br /> Contract No: <br /> ' jl, hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> cane <br /> construct public im rovements in the public way, as described below: <br /> I ~ s-r le t^~ L l c ra <br /> ~ ; Type of Impro ement: <br /> 1 <br /> (paving. wastewater, stormwater, street lights) <br /> i <br /> i <br /> Location: ~ S '~'LL~~ L~ ~..E E~f?~~'t~ <br /> (street or easement work is within or subdivision name) <br /> North (o~ east) limit: C~~ ~1'~~ South (or west) limit: ~ ~ " <br /> f <br /> n strict conforma with City of Eugene standard spec'rfications for public improvements (including current addenda), <br /> onstruction plans proved 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 /> ~ontact Person cv~+ ~ ~~'~~°"G~ <br /> i ! I ) <br /> ~ignature W Mailing Address ~ d' g~ 2 5 Z <br /> I ~'rint signat e h re ~ ~ ~ ~'A"~~~ <br /> i ate ( a Phone ~ 4-~' ~ S"S City /State /Zip CZ S ~ ~ Ul2 ~ 2 <br /> i <br /> { <br /> ~ DO NOT WRITE BELOW THIS LINE <br /> ' PUBLIC IMPROVEMENT PERMIT <br /> ermission 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 /> I <br /> the permit shall be oid unless the work described herein is completed by: <br /> I <br /> SPECIAL CONDITI NS <br /> i <br /> i <br /> ~ APPROVED: Date: <br /> City Engineer <br /> <br /> EOgj 604 ~ FEBRUARY 2aC12 <br /> White: OwnedDesipner Canary: Contractor Pink Inspector <br /> <br />