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_ ~ <br /> City of Eugene <br /> Public Works <br /> <br /> application for Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> T r~~~ Eugene, OR 97401 <br /> Job Number. <br /> (541)682-5291 <br /> FAX: (541)682-5032 <br /> Contract No: <br /> ~LUQ~ o r ~ hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> c~~ <br /> construct public improvements in the public way, as described below: <br /> ~rype of l mprovement: r ~ ' ~ f!t s r .•wc } ~ ~v'~" <br /> (paving, wastewater, stonnwater, street lights) <br /> 1~ocation: ~-~`~t-x•+,•~ ( Lvv~ i L k l,~ k~ se~fia~ <br /> (street or easement work is wNhin or aubdvision name) <br /> 1~`North (or east) limit: South (or west) limit: <br /> In strict conformance with City of Eugene standard spec'rfications 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 performing the work. <br /> ~ontact Person ~o ~ /V/o~ sus, ;S #3 d3. 7/0 • /f13b <br /> signature Mailing Address 1,~s~ 0~~ ~ Gt~~., , s • ~ K 2 u~ <br /> ' Print si nat re here <br /> Date ~ •u • o(- Phone ~5.~7~ /T_ City /State /Zip ~ ~T_/ <br /> DO NOT WtirTE BELOW THIS LINE <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission Is hereby granted to applicant and appiicanYs 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 /> SPECIAL CONDITIONS <br /> APPROVED: Date: <br /> City Engineer <br /> i <br /> Eng: 604 FEBRUARY 2Qft2 <br /> While: OwnedD~igner Canary: Contractor Pink Irmpector <br /> <br />