GJN4665 Application Public Improvement

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I 'I e i 3 Public works Application far Public Improvement Permit Engineering R : City of Eugene ,lob Number, . Contract Number.. ~ ~ ~ ~ ~ 99 E. Broadway, Suite 400 . ~ ~ ~ ~ Eugene, Oregon 9140 ~ X54 ~ } fi82-529 ~ ~54~} 682-5032 FAX I, _ hereby make application far a PUBLIG IMPROVEMENT PERMIT to construct public improvements (owner) in the public way, as described below: f{ l f Type of Improvement: Pavin Stormwater Uvastewater manhole ad'ustments Traffic Si pals Street li hts (Paving, wastewafer, stormwater, street lights.) i Location: Universlt Dlstrfct - Ua Arena PEPI 2 - 8 small sites (Street or easement work is within ar subdivision name) 'i I North (ar east} limit; Franklin Boulevard South for west} limit: 1St" Avenue in strict conformance with City of Eugene standard specifications for public improvements including current addenda}, construction plans approved by the city engineer or his representative, the current edition of "Procedures for Privately Engineered Projects," the Eugene City Code, and the standard and special conditions printed on this permit form. The awnerlapplicant is responsible for providing a copy of this permit to the contractor performing the work. Contact Person sprint I~r ~ ~ ~ ~ ~ Phone Number ~ ~ SIGNATURE Biliing Information: ~ ~ Same ? Dilferer~ see below PRINT SIGNATURE DATE NAME ` ~ ~ A MAILING ADDRESS BILLING ADDRESS ~ ~ ~ ~ CITY STATE 1 ZIP CITY 1 STATE I ZIP PHQNE NUMBER business hours PUBLIC IMPROVEMENT PERMIT . Permission is hereby granted to applicant's contractor to perform the work stated above, in conformance with conditions listed above, below, and on the reverse side of this permit form. The permit shall be void unless the work described herein is completed by; . SPECIAL CONDITIONS Qrrgrnal to the City of Eugene APPROVED: DATE: Copres to Cwner, Ca-owner, and inspector City Engineer