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Public Works <br />Application for Public Improvement Permit Engineering <br />e <br />City of Eugene <br />Job Nu rtber Contract Number 99 E. Broadway S4it&400 <br />Eugene, Oregon 97401 <br />(541) 682-5291 <br />(541) 682-5032 FAX <br />I, hereby make application for a PUBLIC IMPROVEMENT PERMIT to construct public improvements <br />(owner) <br />in the public way, as described below: rr <br />Type of Improvement: PriVn.7e .(1i11;4,4 Tunn¢f V/ 1 fev~ok ►'CR Si~f T¢~jHd <br />y (Paving, wastewater, stormwater, street lights.) <br />Location: ► LOSS S-/Tdrd- <br />(Sttreet or easement work is within or subdivision name) <br />North (or east) limit: JL" t ~/'PLT South (or west) limit: 139/ Sou♦h a o'F <br />in strict conformance with City of Eugene standard specifications 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) p i bO eau Phone Number SA I - 5t' d °I 3 7-'2- <br />xe ~-4-- <br />SIG,NAATURE /l <br />/"`i4 -r r E E-N A,0 J <br />PRINT SIGNATURE <br />DATE <br />MIDI Oak Swle 100 <br />MAILING ADDRESS <br />xu-av.1, O-A 1710 <br />CITY / STATE / ZIP <br />5111- (,eLj llaoa <br />PHONE NUMBER (business hours) <br />Billing Information: <br />Q Same R Different, see below <br />rix ),,k <br />NAME I, <br />u?(. Ulniv es ik a yr .don <br />BILLING ADDRESS <br />1~(4gEnB: ()k V403- 1176 <br />CIT1'f STATE /ZIP <br />PUBLIC IMPROVEMENT PERMIT <br />Permission is hereby granted trs 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 form. <br />The permit shall be void unless the work described herein is completed by: <br />SPECIAL <br />APPROVED: DATE: Anginal to the City of Eugene: <br />City Engineer ` Copies to Owner, Co-gW.nor, <br />an # f Spector <br />