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_ . _ _r _ <br /> i ICI <br /> r ~ <br /> <br /> ~ i <br /> I <br /> City of Eugene <br /> Public Works <br /> '1pp~ication for Rublic Improvement Permit Engineering <br /> _ 858 Pearl Street <br /> Jo~ Number. ~ Eugene, OR 97401 <br /> (541)682-5291 <br /> FAX: (541)682-5032 <br /> C tract No: <br /> ~ ~~S hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (owned <br /> ~o struct public improvements in the public way, as described below: <br /> Type of Improvement: ~ ~ ~ I ~ <br /> (paving, wastewater, stonnwater, street lights) <br /> Location: ~ ~ ~ r <br /> (street or easement work is within or sub vision name) <br /> North (or east) limmit: South (or west) limit: <br /> in strict conformance, with City of Eugene standard specifications for public improvements (including current addenda), <br /> co?tstruction plans approved bythe city engineer or his represerttative,tha current edition of "Procedures for Privately Engineered <br /> Pr~jects," 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 /> Cgntact Person,~r~ ~ <br /> Si nature ' Mailing Address ~ C ~ <br /> 'P nt signature here ~ ' '2-- <br /> D to Phone City /State /Zip ~ ~ L" <br /> i <br /> t)0 NOT WRfTE BELOW THIS LINE <br /> it <br /> PUBLIC IMPROVEMENT PERMIT <br /> P rmission is hereby'~granted to applicant and applicants contractor to perform the work stated above, in conformance with <br /> conditions listed above, below, and on the reverse side of this permit form. <br /> T e permit shall be void unless the work described herein is completed by: <br /> S ECIAL CONDITIONS <br /> A PROVED: Date: <br /> j City Engineer <br /> Eng: 804 FEBRUARY 2002 <br /> VVhlte: Owner/Desiynsr Canary: Contractor PMIc Inspector <br /> <br />