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e <br /> City of Eugene <br /> Public Works <br /> <br /> Application for Public Improvement Permit Engineering <br /> ~ 858 Pearl Street <br /> Jiob Number: Eugene, OR 97401 <br /> (541) 682-5291 <br /> FAX: (541)682-5032 <br /> Contract No: J J / <br /> I, ~ I i /1 4~C,. hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> c~~i <br /> c nstrud public improvements in the public wayj as described beelow: 11 I J J J ,f <br /> 7 of Im rovement: vin a 'h°f~(XtrPr Tot WAI~r 57'~~~ l~ S?/'P~'~ /'~'Pc~ <br /> YPe P <br /> i (paving, wastewater, stonnwater, street Ilghts) <br /> Location: ,Alder Crrek Es7~a~es AUD <br /> I <br /> i (street or easement work is wNhin or subdvision name) <br /> n p 1~ n~~/ <br /> North r east) limit: ~+~rfor 1''Ol)d South (or est limit: R, ver POil1 fY Z - /~d~• <br /> ill strict coMormance with City of Eugene standard specifications for public improvements including current addenda), <br /> ~onskruction plans approved by the city engineer or his representative, the current edition of "Procedures for Privately Engineered <br /> ~roje+c1s," the Eugene City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> spctnsible for providing a copy of this permit to the contractor performing the work. <br /> 'I <br /> contact Person tp?~q TCZm 1 <br /> Signature Mailing Address ?gb 3 l~ i V~'/'WQ 4.~0~ <br /> F~rint signature here *'a-Z ~ ~ n > O <br /> date Phone - City /State / Zip ~ z° / _L_.- <br /> DO NOT WRITE BELOW THIS LJ*IE <br /> j PUBLIC IMPROVEMENT PERMIT <br /> t~errnissfon is hereby granted to applicant and applicant's contractor to perform the work stated above, in conformance with <br /> tortditions listed above, below, and on the reverse side of this pemtft form. <br /> 'rlte permit shall be void unless the work described herein is completed by: <br /> SPECIAL CONDITIONS <br /> APPROVED: Date: <br /> City Engineer <br /> En®: 6D4 FEBRUARY 2042 <br /> While: OwnedDeeipnsr Canary: Contractor PiNc Inspector <br /> <br />