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I <br /> e <br /> I City of Eugene <br /> <br /> ' Public Works <br /> Application for Public Improvement Permit Engineering <br /> ~ i y / p 858 Pearl Street <br /> ` i Job Number. -f~`j ~ / Eugene, OR 97401 <br /> (541) 682-5291 <br /> Contract No: FAX: (541) 682-5032 <br /> 1, Rod Kempf hereby make application for a PUBLIC IMPROVEMENT PERMlT to; <br /> (owner) <br /> construct public improvements in the public way, as described below: <br /> Type of Improvement: Wastewater Pipe <br /> (paving, wastewater, stonnwater, street lights) <br /> i <br /> j location: -13.i~port Industrial Properties <br /> (street or easement work is within or subdivision name) <br /> ~I <br /> North (or east) limit: Lot 4 TL 1 8 0 0 South (or west) limit: <br /> i~t strdct conformance with City of Eugene standard specifications for public improvements (including current addenda), <br /> donsiruction plans approved by the city engineer or his representative, the current edition of "Procedures for Privately Engineered <br /> F?rojects," 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 /> contact Person (a~nA Rod Kempf <br /> Airport Industrial Prop. <br /> S~gnature Mailing Address PO Box 2 0 b 6 <br /> P~•int signature here <br /> Date ~'3 ~ G Phone b89-41 54 City/State/Zip Eugene, OR 97402 <br /> I <br /> DO NOT WRfTE BELOW TiiIS LINE <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is hereby granted to applicant and applicants contractor to perform the work stated above, in conformance with <br /> ~collditions listed above, below, and on the reverse side of this permit form. <br /> 7hje permit shalt be void unless the work described herein is completed by: <br /> i <br /> ~F~ECIAL CONDITIONS <br /> A1PbROVED: Date: <br /> City Engineer <br /> Eng: 60q FEBRUARY 2002 <br /> White: OwnaNDesigner Canary: Contraet0( Pink: Inspet,'tor <br /> <br />