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tca.d.r~ Public Works <br /> w~r~c.~ ~c~ck <br /> <br /> li Application for Public Improvement ermit <br /> Engineering: <br /> - City of Eugene <br /> Job Number ~ Contract Number 99 E. Broadway, Suite 400 <br /> III Eugene, Oregon 97401 <br /> (541)682-5291 <br /> (541) 682-5032 fAX <br /> I ~1~.1 hereb make a lication f r IMP OV PER <br /> o a PUBLIC R EMENT MIT to construct ublic im rovements <br /> pp <br /> y P P <br /> (owner) X12- l•1~dllP~lV 1,1aM~S <br /> in the public way, as described below: <br /> r <br /> Type of Improvement: Paving, Wastewater, Storm Drainage, Street Lights <br /> (Paving, wastewater, stormwater, street lights.) <br /> Location: Meadowview Park Phase 2 <br /> (Street or easement work is wtthln orsubdivlslon name) <br /> North (or east} limit: South (or west) limit: <br /> in strict conformance with City of Eugene standard speci#ications for public improvements (including current addenda), construction <br /> plans approved by the city engineer or his representative, the current edition of "Procedures for Privately Engineered Projects," the <br /> Eugene City Code, and the standard and special conditions printed on this permit form. The owner/applicant is responsible for <br /> providing a copy of this permit to the contractor performing the work. <br /> Contact Person (print} ~ d b~BQ l Phone Number 503-312-0500 <br /> ~N}A't"tJC \ Billing Information: <br /> J<! GNP} t ~ t~ ? Same X Different, see below <br /> PRINT SIGNATURE <br /> 17A"I`E t+tAtulE <br /> 54.1 Div cer ~a - <br /> (v1A1LINt~;•~iDI~R~SS 81i.LINCa At~t7RESS <br /> P. 722 <br /> ~#TY /STATE /ZIP CITY STATE / ZI - - <br /> 5g3.4i&~~Ot3 <br /> PHONE NUMBER (business hours) ' <br /> PUBLIC IMPROVEMENT PERMIT <br /> Permission is hereby granted to applicant's contractor to perform the work stated above, in conformance with conditions listed <br /> above, below, and on the reverse side of this permit #orm. <br /> The permit shall be void unless the work described herein is completed by: <br /> SPECIAL CONDITIONS <br /> Original to the City of Eugene <br /> APPROVED: DATE: Copies to Owner Co owner, and Inspector <br /> City Engineer <br /> <br />