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PROJECT AUTHORIZATION FORM <br />Public Works <br />Engineering <br />City of Eugene <br />99 E. Broadway, Suite 400 <br />Eugene, Oregon 97401 <br />(541) 682-5291 <br />TI oki V1 I <br />Job -4/ <br />Project Title: <br />(location and work description) <br />12, <br />Project Manag / Contact / Private Engineer <br />PROJECT SCOPE: <br />Paving <br />Concrete walks-----, _ <br />(length) <br />Wastewater <br />Signal <br />New building construction <br />Other <br />Bike lanes / paths- <br />(widths) <br />Setback / Curbside <br />(width) <br />Stormwater <br />Landscaping___ <br />Street lights _ <br />ROW required - <br />Planning, other <br />Remodel <br />(width) <br />FUNDING SOURCES: Check ALL applicable funding sources fixed) <br />City__ Assessments Private Bond Other Dept._______ <br />Fed _-State County FAA___,_ Grant <br />Account codes <br />APPROVED: <br />~ - <br />Project Manager_ - - - - - Date <br />Principal Engineer Date <br />Other Manager Date_ <br />City Engineer Date <br />- <br />FOR USE BY ADMINISTRATION ONLY <br />Capital Project No. 91,51-74 _ ACK 3 q3 " 13,2d - (a xz- - <br />GL Title- <br />Assigned by Date <br />Acco2in by_ Date- _ <br />SID PB _ GL , JC_ JE o~ <br />ATTACHMENTS: <br />``Project Budget Summary ❑ Developer Agreement ❑ Engineer's Report On Improvement Petition <br />❑SDC Budget Worksheet ❑ Engineering Agreement ❑ Engineering Service Work Request <br />❑ City Engineer's Initiating Order ❑ Public Improvement Permit Application ❑ Map or Drawing <br />❑ Request for Scoping Meeting <br />WHITE/Finance YELLOW /Administration File PINK/ Engineering File GOLDENROD/ Project Manager April 2010 <br />COMMENTS / SPECIAL PROJECT INFO. / INTERDEPARTMENTAL WORK DESCRIPTION: <br />