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.1 . <br /> . City of Eugene <br /> Public Works <br /> Appiicafiion for Public Improvement Permifi Engineering <br /> ~~;E'~~e- 0 ~~1 ~ "`~~~~'l/1~ E58 Pearl Street <br /> Job Number: ~ i0/~ ~ gene, OR 97401 <br /> (541)682-5291 <br /> <br /> ~ ~ Contract No: ~ PAX: (541) 682-5032 <br /> i <br /> -h hereby make application for a PUf3UC IMPROVEMENT PERMIT to <br /> (owned <br /> construct public improvements in the public way, as described below: <br /> `~A~lt iv ~ <br /> i Type of Improvement: <br /> (paving, wastewater, stormwater, sheet Ilghts) <br /> I _ ~ Ag <br /> ~ Location: c,°'~~iZG ~ . <br /> i <br /> (street or easemerrt work is within or subdivision name) <br /> i North (or east) Amib ~+Vv>z~xf ~ ~t/+tc1,~14ENz1 _ .South (ar west) limit: ~a~ ~Na1~"N~ oF' ltJJCC~~+ZI~ <br /> j <br /> i <br /> in strict conformance with City of Eugene standard specifications for public improvements (including current addenda), <br /> consttvction plans approved bythe city engineer or hls representhtive, the current edition of "Procedures for Privately Engineered <br /> Projects ;the Eugene City Code, and the standard and special conditions printed on this perrrtlt form. The owner/applicant is <br /> responsible for providing a cmp/y <br /> of this permit to the contractor performing the work. <br /> Contact.Person (~f ~ ~c° /i ~.-r' J' (`-~i"'~- <br /> / / <br /> Signature Mailing Address ~ ~ ~ d/'~ i`K Sf <br /> Print signatu here -S~~l~~ ,~i_-- s I <br /> i Date /z a Phone .S~!/- 7~/ / City /State /Trp C~~ ` J ~/a / <br /> i <br /> . OO NOT WRITE BELOW THIS LINE <br /> PUBIC IMPROVEMENT PERMIT <br /> Permission is hereby granted to applicant and applicant's contractor to perform .the work stated above, in conformance with <br /> conditions fisted above, below, and on file reverse side of this permit forma <br /> i The permit shall be void unless the work described herein is completed by: <br /> SPECIAL CONDITIONS <br /> APPROVED: ~ Date: <br /> City Engineer <br /> i. <br /> Eng: 604 ~ FEBRt1ARY 20QP <br /> While:OxmedDasigner Canary: ContraaUor Plnk: hrepeclor <br /> <br />