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~ b. ~ ~ <br /> ~ <br /> City of Eugene <br /> Public Works <br /> A~ ` lication for Public Improvement Permit Engineering <br /> n ~ 858 Pearl Street <br /> ,Job Number. Gf Eugene, OR 97401 <br /> (541)682-5291 <br /> FAX: (541)682-5032 <br /> Contract No: <br /> I, i',',-' ~iJ/'J{~ ~1i X71 <br /> ~,~'~ly.~ hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> c ~ i <br /> construct public improvements in the public way, as described below: <br /> Type of Improvement: ` ~,y~F~~St[ ~ <br /> (paving, wastewater, stormwater, street lights) <br /> Location: r I L~3~ ~ <br /> ~ r~~~ <br /> i <br /> (street or easement work is within or sut~vlslon name) <br /> North (or east) limit: ~~f%S~L~ 17~' . South (or west) limit: ~'i~>D `J , <br /> in strict conformance with City of Eugene standard specifications for public improvements (including current addenda), <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 /> ;responsible for providing a copy of this permit to the contractor pertorming the work. <br /> I I <br /> 'Contact Person ca~Mi ~ <br /> /~~~lT'~~~ <br /> <br /> ~tr , <br /> ,Signature % J Y Mailing Address G% ~ ~ <br /> Print signature here ~ ~ ~ <br /> Date -T Z - e%C Phone Sim <br /> ~1-? <br /> ~~,elyCity /State /Zip C%~ I/~/~ <br /> 0o rwr wry etiow TMrs u+a: <br /> PUBLIC IMPROVEMENT PERMIT <br /> •i <br /> Perrnission is hereby granted to applicant and applicant's contractor to perform the work stated above, in conformance with <br /> ;conditions listed above, below, and on the reverse side of this permit forth. <br /> The permit shall be void unless the work described herein is completed by: <br /> SPECIAL CONDITIONS <br /> I <br /> i ;APPROVED: Date: <br /> City Engineer <br /> &ttg: 604 FEBRUARY 2Ur72 <br /> White: OwnedDeelpner Canary. Gor~trador Pirdc Irmpector <br /> <br />