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, <br /> City of Eugene <br /> <br /> . O Publie Works <br /> Application for Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> Job Number. ~12~0 Eugene, OR 97401 <br /> (541)682-5291 <br /> FAX: (541)682-5032 <br /> Contract No: <br /> I. hereby make application for a PUBLIC IMPROVEMENT PERMR to < <br /> towren <br /> construct public improvements in the public way, as described below: <br /> Type of Improvement: ~5~~ WAT~ <br /> Ipawrg, wastewater, arnmwater, street tights) <br /> Location: W~STM GRE L /AND V' ~ L L h C; ~ <br /> fsn'ee[ or easement work is within or subdivision name) <br /> ,Dlerth(oreast)Iimit:y~l~I=IE~-~ 5~~r South (orwest)limit~~ ~yENU~ <br /> in strict conformance with City of Eugene standard specifications for public impttrvements (including current addenda), <br /> construction plans approved bythe city engineeror 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 pernk form. Theowner/applicant is <br /> responsible for providing a copy of this permit to the contractor performing the work. <br /> Contact Person tpmm ~t~1-~,r1 ~aC=;,,',.~~t/l/5R <br /> Signature ,~/r-~^~y ~ Mailing Address ~9 ~rj t-r) (4+~~ ~Pu~ <br /> PriMSign rehere t`~~e_( f1'Cc~nn[.( <br /> Date Phone 5W t - joa -503 l~ City /State / Ztp ~ e e t hZ 7 ~ c~U <br /> bo tar vrarte etanw nas r.aff <br /> - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - <br /> PUBLIC IMPROVEMENT PERMR <br /> Permission is hereby granted to applicant and applicant's contrndor 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 /> Eng: 604 FEBRUARY 2002 <br /> WMte: OwnooDesipnx Canal Camraaor Pink: Inspector <br /> <br />