New Search
' , <br /> City of Eugene <br /> Public Works <br /> <br /> Apjplication fo Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> Job Number: S Eugene, OR 97401 <br /> (541)682-5291 <br /> ~ FAX: (541)682-5032 <br /> Contract No: ~1 <br /> i~ ~ P, .a ,2s !f, ~ ~ L-C. hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (owner) <br /> ',construct public im rovements in the public way, as described below: <br /> , ~ 1 <br /> Type of Impro ement: /Jc~ tr ~ ` 'x-,ai'r?-.I.~`c~'~t r S l~-fi " ~j C 1 <br /> (paving, wastewater, stomtwater, street lights) <br /> Location: ~ r <br /> i ((street or easement work is within or subdivision name) ~ [ <br /> I' North (or mit: - ~ "-`'t South (o st limit; ~ ~ ~ "~%Q y <br /> in strict conforms ce with City of Eugene standard specifications for public improvements (including current addenda), <br /> construction plans proved bythe city engineeror his representative, the current edition of "Procedures for Privately Engineered <br /> 'Projects," the Eug ne City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> responsible for p iding a copy~oif <br /> this <br /> pYermit to the contractor performing the work. <br /> Contact Person ca, ~t, tS c <br /> s~ ~~G'~t ~ ~~r. <br /> Signature Mailing Address ZSL 7 <br /> Print signet re he ~ j ~ <br /> Date ~ Z Phone 8 ~ ~ ' City /State /Zip ~'-~Q-~ ~ ~ g~ ~ <br /> DO NOT WRITE BELOW THIS LINE <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is he y granted to applicant and applicants contractor to perform the work stated above, in conforrnance with <br /> conditions listed ove, below, and on the reverse side of this permit form. <br /> The permit shall void unless the work described herein is completed by: <br /> SPECIAL CONDI IONS <br /> APPROVED: Date: <br /> City Engineer <br /> ; <br /> Eng:'604 I', FEBRUARY 2'002 <br /> ii Wtdte: OwnedDsaipner Canary. Corrtrsctor Pink Inspector <br /> <br />