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~ ' <br /> ' MAR 2 7 2006 <br /> <br /> i City of Eugene <br /> Public Works <br /> Application for Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> Job Number: Eugene, OR 97401 <br /> (541) 682-5291 <br /> FAX: (541) 682-5032 <br /> Contract No: <br /> II Nleltebeke Construction hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (owner) <br /> construct public improvements in the public way, as described below: <br /> Type of Improvement: Wastewater <br /> (paving, wastewater, stormwater, street lights) <br /> Location: The Fountains of Park Place <br /> (street or easement work is within or subdivision name) <br /> North (or east) limit: South (or west) limit: <br /> irn strict conformance with City of Eugene standard specifications for public improvements (inc{uding current addenda), j <br /> construction plans approved by the city engineer or his representative, the current edition of "Procedures for Privately Engineered, <br /> Projects," the Eugene City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> rtEsponsible for providing a copy of this permit to the contractor performing the work. <br /> ~)ade Holada I <br /> Contact Person (print) y-Olson & Morris ff <br /> I <br /> S~ nature 2315 Park View Drive I <br /> 9 r Mailing Address i <br /> Pint signature here l,accv~ ?J ?'rl eL-~-~ ~e(~• 1 <br /> D~te Phone 541-343-3561 City !State /Zip Eugene, OR 974U8 <br /> i <br /> DO NOT WRITE BELOW THIS LINE <br /> '---t <br /> PUBLIC IMPROVEMENT PERMIT 1 <br /> jP ~rmission is hereby granted to applicant and applicant's contractor to perform the work stated above, in conformance with ~ <br /> ~o~ditions listed above, below, and on the reverse side of this permit form. <br /> II i <br /> i <br /> '1-h~e permit shall be void unless the work described herein is completed by: ~ <br /> --II <br /> SPIECIAt. CONDITIONS <br /> i ~ <br /> i <br /> 1 <br /> ,I i <br /> AP~ROVED: Date: <br /> City Engineer <br /> 1 <br /> I <br /> 1 <br /> I <br /> Eng: 604 FEBRUARY 20(72 <br /> White: OwnedDesigner Canary: Contractor Pink: Inspector <br /> <br />