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city of Eugene <br /> Public Works <br /> Appiication for Public Improvement Permit Engineering <br /> II 858 Pead Sireet <br /> Job Number. ~ ~ ~.fL v~J Eugene, OA 87401 <br /> {b41) 8825291. <br /> FAX: (541)682-5032 <br /> Contra~c/~t No: / ' <br /> t, 1 YIG . ~IC/tiIG ~ ~ t~'OLGp hereby make applfcagon for a PUBLiC IMPAOVEMEN7 PERMR to• <br /> t~l <br /> construct putilic improvements ~ tthe publil_c_w-a-y,.fe~s _descri((bed below: !r'~ 11 <br /> -Type oflmprovement'. (Jort~lytT~CU?+ ~y,b~tNSron -37 StA~~C T~Nrr~~t2'St1Crs~t4~ LOCS <br /> (pavtrrg, v2sterwter, stsnnwaler, street lights) <br /> Lo~tron: _ ASS 1Jotft~hawt /~?c,, F.t.t~evt~~o2 9~tiFo~- <br /> (street a1eas'ement Mork is wIOUn or wb~rvisia+ rramej <br /> Nonh (ar east) limit: $GCnrG 1~¢a~Ow 5 5ulod. South (orwesQ Omit: kVQtSon ~ye <br /> in strict conformance with City of Eugene. standard spedfcetiorts for public improvemems (indutling arrent addenda), <br /> wnstrurxion plans approved bythe dfy engineerorhis representative, the currem edition of °Procedures for privately Engineered <br /> Projects; the Eugene City Code, and the standard and spec~l conditions printed an this permit Ieml. The owner/applicant is <br /> responsible for providing a copy of this permit to the oontrac[or performing the wodc <br /> confect Person tvroa N«holas PEE-tS ,n <br /> Signature ~ t'A.Y'tWe~ Mailing Address ~~g S• W ~~IS ~¢rr~ YCd . <br /> Print signet re here aQr C. PEErS <br /> .Date Z c Ph ne~ city/ware/zip ~Or~'ju-nA~02 `1 <br /> ~4oca.( e. <br /> oo sot wwreertnwnea ~ <br /> PUBLIC IMPROVEMENT PERMR <br /> Permission is hereby grerrtetl to applicant end applicant's contractor to pedonn the work stated above, In coMomrance with <br /> conditions listed above, below, end on the reverse side of this permit form. <br /> The permit shall be void unless the work described herein b completed by: <br /> SPECIAL CONDITIONS <br /> APPROVED: Dater <br /> City Engi <br /> <br /> Eng: 604 FmituRr 2ooz <br /> - vmne:ow.a~nesyna Ca,wy. CoMaaor PiMC Inenaerw <br /> <br />