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03/;24,,/~006~ 10:16 F 541 682 6030 CITY EUGENE Pw ENG f~J 003/003 <br /> • <br /> City of Eugene <br /> Pubik Works <br /> A~pplicetion fo Public Improvement Permlt Engineering <br /> 856 Pearl Street <br /> . I Job Nixttber. (94~n862- <br /> 291401 <br /> FAX: (541)682.5032 <br /> Contract fVo: <br /> I, o lN~ ~ ER- i~ hereby make apptlcatiort for a PIJBLIC iMPROVEMFJdT PERMIT to <br /> Construct publb kn rovemertis in the puWlc way, as described below: <br /> Type d Irttlf ant' ~WINSy KIAST~WAfr~, _~Rmwf!`lYcft, S~f&T t~`e4~ <br /> (paWnp, M1Yfswat9r, stonnlMifer, street Ides) <br /> Location: ~>z 3t`RtzY SvrsD vistowi <br /> (serest a ~sunwrn work ~ e~tlrn a a~edlwatan rmpe) <br /> Norlh (or a~1 'mlt: yy° ~ sF OA-k+NAY Sow (or~ Ilmit: i-?v, <br /> in strict Conf with Clty of Eugene standard specifkations for public Improvements (indrx6ng curr~ertt addenda), <br /> oonstnictlon plans roved by the clry engineer or his r~epresernative, the gJtretrt edition of "procedures for PAvately Engineered <br /> ProJecis,' the Euge a City Gods, and the standard anti spade) oonditiorts printed on this F~ermk form. Tha owner/appl~arrt Is <br /> njsponsible for prov a copy of this permit to the contractor performing the work <br /> Confect Person iv~rnq "Tor?~ N~A-L'r'E7~ <br /> <br /> ~r' <br /> 2v°G3 P.1rer.~.tK <br /> slgnat<rre Malnng Address <br /> Print sign re ere e <br /> ~ 4ate Phone "b City /Stets / Z'ip R q],~I <br /> ~ oo Nor wnrte saownrs ~ <br /> PUBLIC IMPROVEMENT PERIkIT <br /> I <br /> Rermissbn ie he grrautted to applicant and applicant's contractor to perform the work :Mated above, In coMonnance with <br /> obndltfons listed e, below. and on the reverse side of this permR form. <br /> 7t1e permit shall be oki unless the work descn"bed herein is completed by: <br /> SPECIAL CONDiTI S <br /> APPROVED: Date: <br /> City Engineer <br /> i <br /> I <br /> i <br /> i <br /> i <br /> Enp~' 601 FEBRUARY 2082 <br /> 'i vN~Me; Own.xoegtir Canary: Conlr~or Pwc Inepee[u <br /> <br />