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.j <br /> ~ - . <br /> C'Ity of Eugene <br /> ` Publlc Works <br /> Engineering <br /> <br /> . A ' plication for Public Improvement Perrr~it ~ ~ R _ ~ ~nn~ ~ . <br /> - ~ 858 Pearl Street <br /> Job Number. i- . ~ Eugene, OR 97401 <br /> (541) 682-5291 <br /> FAX: (541)682-5032 <br /> ~ Ctontract No: <br /> I,~ - 5N K hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> t~~ <br /> c~nstruct public imp vements in the publlc way, as described below: <br /> Type oflmprov ment: PP"`iINC~G_ V(L73 hrrY.~ t-IC~F-~T3~ ~.•~A~s'~4.wi~t'~'~tz.. ~fl'v1~My~/p-r,~_ <br /> (paving, wastewater, storrnwater, street lights) <br /> Location: u ICE t ~ o rJ <br /> (street or easement work is within or subdivision name) <br /> North (or east)1 mit: South (or west) limit: <br /> i <br /> in strict conforman with City of Eugene standard specifications for public improvements (including current addenda), <br /> ponsiruction plans proved bythe city engineeror his representative, the current edition of "Procedures for Privately Engineered <br /> Projects," the Euge a City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> responsible for prov ding a copy of this permit to the contractor performing the work. <br /> Contact Person [pn ..ic~st=_P t'f ~l-k A Q i TMC/~ <br /> Signature ~ ~ Mailing Address yd `'j ~ r22. ~-I''~~~-- !'SV'E <br /> Print sign ure here ~ ~ ~p N S ~!?"'I~/~ <br /> bate - Phone S) 7 ' 70 I $ City /State / Zip ~ ent_ ~ ~ ~ ~C <br /> i <br /> 0o rotor wt~ e~ow rrtts t.trtt; <br /> t------ <br /> PUBLIC IMPROVEMENT PERMIT <br /> ~ 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 /> ~T'tte permit shall be void unless the work described herein is completed by: <br /> i <br /> ~SPEClAL CONDITI NS <br /> JI <br /> j ;APPROVED: Date: <br /> City Engineer <br /> I <br /> I <br /> i <br /> Etlq: ~ ~ FEBRUARY 2002 <br /> White:Ownsdt)esipner Crory: Cornractor Plnlc Irrepeetor <br /> <br />