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Public Works <br />PROJECT AUTHORIZATION FORM <br />Engineering <br />City of Eugene <br />99 E. Broadway, Suite 400 <br />Eugene, Oregon 97401 <br />Job (541)) 682-5291 <br />Project Title: + J`7__-_ <br />(location and work description) <br />Project Mana / Contact / Private Engineer: <br />PROJECT SCOPE: <br />Paving _ <br />Concrete walks------- <br />(length) <br />Wastewater <br />Signal - - <br />New building construction <br />Other <br />(widths) <br />Stormwater <br />Street lights <br />Planning, other <br />FUNDING SOURCES: Check ALL applicable funding sources fixed) <br />City_-_---Assessments--__-__ Private <br />Fed_^----State County <br />Account codes <br />Bike lanes / paths--- <br />(width) <br />Setback / Curbside <br />Landscaping- <br />ROW required <br />Remodel <br />Bond Other Dept. <br />FAA Grant <br />APPROVED: <br />- <br />Project Manager Date-_1GD <br />Principal Engineer &L JL, Date- <br />Other Manager - Date-- <br />City Engineer Date <br />1 -11.1 FOR USE BY ADMINISTRATION ONLY <br />Capital Project No. 102 ACK 3,(3 2-x = 9i~ <br />-9 Ll <br />GL Title <br />Assigned <br />Accounting b - - L )ate- <br />SID <br />SID PB GL - - JC JE_Z <br />ATTACHMENTS: <br />Wfroject 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 *v ap or Drawing <br />❑ Request for Scoping Meeting <br />(width) <br />WHITE/Finance YELLOW /Administration File PINK/ Engineering File GOLDENROD / Project Manager April 201 0 <br />COMMENTS / SPECIAL PROJECT INFO. I INTERDEPARTMENTAL WORK DESCRIPTION: <br />