New Search
Gity of Eugene <br />Public Works <br />Application for Public improvement Permit Engineering <br />858 Pearl Street <br />Job Number: Eugene, 4R 9?401 <br />X541 } fi8~-5291 <br />FAX; X541 } fi82-5o32 Contract No: ' <br />I, ~i ~ ~ h f ~ hereby make application for a PUBLIC IMPROVEMENT PERMIT to <br />downer} construct public improvemen#s in the public way, as described beiow: <br />. ~ ~ Type of I mprovement. ~ ~ <br />paving, wastewater, starmwater, street lightsy <br />~ <br />Location. <br />street ar easement work is within or subdivision name) <br />~ . z <br />North ore t II ~ ~ as } m t. South for west} Ilm~t. <br />in strict conformance with City of Eugene standard specifications for public improvements including current addenda}, <br />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 <br />special conditions printed on this permit form, The ownerlapplicant is <br />responsible for providing a copy of this permi# to the contractor performing the work <br />Contact Person ` ~ k <br />Signature ~ . ~ .3 f Mailing Address <br />Print si na a here <br />Date ~ ~ ~ ~ ~ Phone Ity 1 State 1 Zlp <br />na ~vr wam~ e~~ow rHis uNe <br />~ ~ .r...,.._ ~ <br />PUBLIC IMPRQVEMENT PERMIT <br />Permission is hereby granted to applicant and applicant's contractor to perform the work stated above, in conformance with <br />conditions listed above, beiow, 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 CONDITIQN5 <br />APPROVED: Date: <br />City Engineer <br />~~9~ 6~~ FEBRUARY White' O~rnerlQesEansr Canarv: Contractor Pinky Insaacter <br />