New Search
.R ~1A <br /> City of Eugene <br /> Public Works <br /> Application for Public Improvement Permit Enginee"ng <br /> 858 Pearl Street <br /> Job Number. Eugene, OR 97401 <br /> (541) 682-5291 <br /> FAX: (541) 682-5032 <br /> i 4ontrad No: <br /> 1, hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (mod- <br /> <br /> • oonstrud putilic improvements in the public way, as described below: <br /> T of Im rovement: ~ ~ ~'t (''u~ <br /> YPe P <br /> (paving, wastewater, stomtwater, street Iighffi) <br /> Location: ,l ~ ~k~i~ t~ `~J ~..1~~'~t~l ~l <br /> S /C~ %1/, <br /> (street or easement work ffi within or subdvlsion name) <br /> I <br /> I <br /> North (or east) limit: South (or west) limit: <br /> in strict contom~ance with City of Eugene standard specifications for public improvements (including current addenda), <br /> cronstruction 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 performing the work. <br /> ~ 7~'c' vV~•- <br /> Conffict Person taa,q <br /> Signature 4~.r-~- ~ ~ Mailing Address <br /> ~ <br /> Print si at re here <br /> ~ I <br /> Date Phone ~.~r- /!y[//"~ City /State / Zip _ ~ <br /> DO NOT WRITE BELOW THIS UNE <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is hereby granted to appllT~nt and applicants contractor to perform the work stated above, in conformance with <br /> conditions listed above, below, and on the reverse side of this permit form. <br /> The permit shall be void unless the work described herein is completed by: <br /> i <br /> j SPECIAL CONDITIONS <br /> APPROVED: Date: <br /> City Engineer <br /> EDQ: 604 FEBRUARY 202 <br /> White: CwnedDesigrrer Canary. Contractor Pink Inspector <br /> <br />