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1 <br /> City of Eugene <br /> Public Works <br /> . Application for' Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> ',Job Number: -7 `7~ ~ Eugene, OR 97401 <br /> (541) 682-5291 <br /> FAX: (541) 682-5032 <br /> (Contract No: <br /> il, W ~/K. T <br /> ~ i~TULC ~ N 'T hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> ~ (owner) <br /> construct public improvements in the public way, as described below: <br /> ~ n <br /> Type of improvement: C~~J!'~~ C <br /> = 5; C~c'it~~/~C.~ GUEtS ~c'w~'t T P/~ STc~/Yl7t~~ct ~t'~'. S ~~~'~'7 9~'1 rS <br /> (paving, wastewater, stormwater, street lights) <br /> I Location: ~NC~ur l~~c"~~ ~tx./r~V.~S ~ C~?, <br /> (street or easement work is within or subdivision name) <br /> orth or east) limit: ~ r South (or est imit: f C~1r'' S ~-~/1~~ n y <br /> iih strict conformance with City of Eugene standard specffications for public improvements (including current addenda), <br /> gonstruction plans approved by the city engineeror 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 (pdnq ~s^ ?t:C t'~~r c./'f ~ ~ <br /> <br /> +`rr <br /> Slignature~-~"'-y Mailing Address 7~S ~7•~~~5 <br /> Plrint signature here ~ ` <br /> Dlate 4 - ~ 3 ~ ~ Phone 5'y~ ~~_.`L~c~ City /State /Zip~T ~ ~ yn s <br /> DO NOT WRITE BELOW THIS LINE <br /> I <br /> ~ PUBLIC IMPROVEMENT PERM{T <br /> ` Permission 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 form. <br /> Tl~e permit shall be vpid unless the work described herein is completed by: <br /> I <br /> Sf~ECIAL CONDITIONS <br /> i <br /> i <br /> ~AF!PROVED: Date: <br /> City Engineer <br /> Eng: 6D4 FEBRUARY 2002 <br /> White: OwnedDesigner Canary: Contractor Pink: Inspector <br /> <br />