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City of Eugene <br /> Public Works <br /> Application for Public Improvement Permit Engineering <br /> 858 Pearl Street <br /> . $ Eugene, OR 91401 <br /> Job Number. <br /> X541 } fi82-5291 <br /> FAX: X541 } fi82-5432 <br /> Contract No: <br /> 1, ~GQit'~ +Q... RBI hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br /> (owner <br /> construct public improvements in the public way, as described below: <br /> Type of Improvement: ~ ~`~01~ ~ ~ <br /> ~pavin~, wastewater, stormwater, street lights <br /> Location. ~ <br /> {street or easement work is within or subdivision Homey <br /> ' ' • _ D • South or west limit: ~ ~ <br /> Nol~h for east} limit. . ~ } <br /> in strict conformance with City of Eugene standard specifications for public improvements including current addenda}, <br /> construction plans approved bythe 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 ownerlapplicant is <br /> responsible for providing a copy of this permit to the contractor performing the work. <br /> Contact Person ~arinR ~E~ +~h`~'~ ~ <br /> i natur <br /> S g Mailing Address <br /> Print signat re ere ~ • o~ ~ <br /> Date Phone City 1 State 1 Zip <br /> DD NGT IiVRIT~ B~E,OW THIS ~N~ <br /> PUBLIC IMPROVEMENT PERMIT <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 /> The permit shall be void unless the work described herein is completed by: <br /> SPECIAL CONDITIONS <br /> APPROVED: Date: <br /> City Engineer <br /> <br /> frig: 604 FE9RUARY 20Q2' <br /> Whke: DwnerlDesigner Canary: Contractor Pink: ins actor <br /> <br />