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O <br />a <br />PROJECT AUTHORIZATION FORM <br />Engineering <br />Public Works <br />Service ID: SID ✓ PB GL/ <br />Project title: m e, ed <br />(location ork desciiPM017) 1 <br />.vet 1 i~a i } v --e-+ I ti t°S f~ <br />Project manager / contact / private engineer: <br />PROJECT SCOPE: <br />Paving: <br />(widths) <br />Concrete walks: _ <br />(length) (width) <br />Wastewater <br />Stormwater <br />City of Eugene <br />244 E. Broadway <br />Eugene, OR 97401 <br />(541) 682-5560 <br />JC ZJE 14 1'A <br />Bike lanes / paths: <br />(width) <br />Setback / Curbside _ <br />Landscaping <br />Signal Street lights ROW required <br />New building construction Planning, other Remodel <br />FUNDING SOURCES: <br />City Assessments Private <br />Other department <br />f Account code <br />F / State ounty / FAA t fixed) <br />COMrr /ANTS /SPECIAL PROJECT INFO. / INTERDEPARTMENTAL WORK DESCRIPTION: <br />APPROVED: <br />Project Manager <br />Principal Engineer _ <br />Facilities Manage <br />City Engineer <br />Date <br />Dates IO <br />Date <br />Date <br />FOR USE BY ADMINISTRATION ONLY <br />Capital Project No. Mne ACK <br />GL Title <br />Assigned by <br />Accounting by <br />Date,5/P© lio <br />Date <br />ATTACHMENTS: <br />❑ Budget Estimate ❑ Developer Agreement ❑ Engineer's Report On Improvement Petition <br />❑ SDC Budget Worksheet C Engineering Agreement ❑ Engineering Service Work Request <br />❑ City Engineer's Initiating Order ' Public Improvement Permit Application ❑ Map <br />❑ Request for Scoping Meeting A~b q,b5;7-~ <br />ENG 415 WHITE/Finance YELLOW/ Administration File PINK/ Engineering File GOLDENROD/ Project Manager ✓UL Y2004 <br />f <br />