New Search
' • f <br /> ~ <br /> <br /> ' City of Eugene <br /> Public Works <br /> /application for Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> Job Number: ~,,57~ Eugene, OR 97401 <br /> (541) 682-5291 <br /> Contract No: FAX: (541) 682-5032 <br /> j <br /> I, hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (owner) <br /> construct public improvements in the public way, as d~lescribed below: <br /> TYPe of Improvement: ~~LS'~ N(al~ Cl,~ 5~-a1'Vv~~N~ r-~.GOCse~'{b''t') <br /> (paving, wastewater, storrnwater, street lights) <br /> ~JI?Iard s},~~- <br /> Location: <br /> C 1 (street or easement work is within or subdivision name) 1 ~ " ~ <br /> North (or east) limit: r ~~?~1~~1V) ~~uG?-' South (or west) limit: ~~6, 1?~! fi~ FrGLVI l~l,t~ ~~~1~ <br /> in strict conformance with City of Eugene standard specifications 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 /> Contact Person tpnrm C7~-~.0 <br /> Signature Mailing Address ~ 1~"Y`~---~~-(~t v D l <br /> Print signature her ~r~+?+~~5 <br /> Date ~ 'a 3 Phone "~-Z~''-~ City /State / Zip ~ L ~ 7'~ b' <br /> DO NOT WRITE BELOW THIS LINE <br /> PUBLIC IMPROVEMENT PERMIT <br /> I <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 /> i <br /> ~ The permit shall be void unless the work described herein is completed by: <br /> SPECIAL CONDITIONS <br /> i <br /> i <br /> ~i <br /> APPROVED: Date: <br /> City Engineer <br /> III <br /> j <br /> ~ng1604 FEBRUARY 2002 <br /> White: OwnedDeaigner Canary: Contractor Pink: Inspector <br /> <br />