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t <br />PROJECT AUTHORIZATION FORM <br />Public Works <br />Engineering <br />Job l 'J <br />Project Title: <br />(location and work description) <br />6 <br />City of Eugene <br />99 E. Broadway, Suite 400 <br />Eugene, Oregon 97401 <br />(541) 682-5291 <br />SiJ15 C FV'%J <br />Project Manager / Contact / Private Engineer: <br />PROJECT SCOPE: <br />Paving <br />(widths) <br />Concrete walks <br /> <br />(length) <br />Wastewater Stormwater - <br />Signal Street lights - <br />New building construction Planning, other <br />Other _ ;kL_-i16i0i►C-W-,nz4 <br />FUNDING SOURCES: Check ALL applicable funding sources fixed) <br />City_~--Assessments Private Bond _ Other Dept._---__ <br />Fed__----State County FAA--_ _ <br />Grant <br />Account codes <br />TS / SPECIALL PROJE T INFO. INTERDEPARTMENTAL WORK DESCRIPTION: <br />APPROVED: a <br />Project Manager- - Date- <br />Principal Engineer Date <br />Other Manager _ Date <br />_ <br />City Engineer - - Date <br />Capital ProjE <br />GL Title, <br />Assigned by <br />Accou7PB--I/- by _ Date,- - <br />SID GL JC_-JE_V <br />A TACHMENTS: <br />roject Budget Summary ❑ Developer Agreement ❑ Engineer's Report On Improvement Petition <br />❑ C 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 />(width) <br />Bike lanes / paths-_- <br />Setback / Curbside (width) <br />- <br />Landscaping- <br />ROW required <br />Remodel <br />FOR USE BY ADMINISTRATION ONLY <br />