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~ } <br /> ' ' <br /> <br /> • ~ City of Eugene <br /> Public Works <br /> placation f r Public Improvement Permit Engineering <br /> _ 858 Pearl Street <br /> Job Number. `J' Eugene, OR 97401 <br /> (541)682-5291 <br /> FAX: (541) 682-5032 <br /> Contract No: <br /> I, hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> t <br /> construct public i provements in the public way, as described below: <br /> Type of Imp vement: I" ` ~v''Y ~ ~1 ~ <br /> (paving, wastewater, stomtwater, street lights) <br /> Location: <br /> (street or easement work Is wNhin or subdvislon name) <br /> I <br /> Nort (ore ) limit: ~ '~i~ b-~ ~ South or west) limit: ~ ~ ~ ucZ. ~ <br /> ~ C'~ <br /> in strict conform nce with City of Eugene standard specifications for public improvements (including current addenda), <br /> construction plan approved by the city engineer or his representati\re,tha current edition of "Procedures for Privately Engineered <br /> ~ Projects," the Eu ene City Code, and the standard and special conditions printed on this permit form. The owner/applicant is <br /> responsible for p iding a copy of thi ermit to the r <br /> clot performing the work. <br /> ~,e~ ~~ic~o~ <br /> Contact Perso <br /> ' Si natu Mailing Address ~d <br /> 9 <br /> Print si to re ~ ~ <br /> Date Phone City /State /Zip ~ ~C <br /> j <br /> 3~S ~6e2`~ <br /> 0o taor wnlrE sFaow trls uNe <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is he by granted to applicant and applicants contractor to perform the work stated above, in conformance with <br /> conditions listed ova, 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 /> t:ng: 604 ,~eFrunRr Zap <br /> While: Owner/Desipner Canary: Contractor Pink Inspector <br /> <br />