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PROJECT AUTHORIZATION FORM Public Works <br />Engineering <br />Job Project Title: l ~ 14 !2Lr1 Cl <br />- <br />(location and work description) ~J <br />Ma an ge Contact / Private Engineer: <br />PROJECT SCOPE: <br />Paving <br />Concrete walks---_ <br />(length) <br />Wastewater <br /> <br />Signal- - - <br />New building construction <br />Other <br />(widths) <br />(width) <br />Stormwater - <br />Street lights <br />Planning, other <br />FUNDING SOURCES: Check ALL applicable funding sources fixed) <br />City- iAssessments__----__ Private Bond Other Dept. <br />Fed State <br />Account codes <br />County <br />COMMENTS / SPECIAL PROJECT INFO. / INTERDEPARTMENTAL WORK DESCRIPTION: <br />Grant <br />APPROVED: <br />Project Manager- x Imo'- <br />Principal Engineer <br />Other Manager <br />City Engineer _ <br />FOR USE BY ADMINISTRATION ONLY <br />Capital Project No. _ <br />GL Title <br />Assigned by <br />Accounting by_-- <br />SID Z PB__~/ _ GL <br />ATTACHMENTS: <br />;Project Budget Summary <br />❑ SDC Budget Worksheet <br />❑City Engineer's Initiating Order <br />❑ Request for Scoping Meeting <br />JC_ V" JE <br />City of Eugene <br />99 E. Broadway, Suite 400 <br />Eugene, Oregon 97401 <br />(541) 682-5291 <br />Bike lanes / paths---- <br />(width) <br />Setback / Curbside <br /> <br />Landscaping- <br />ROW required <br />Remodel <br />Date i o <br />Date-LZ <br />Date <br /> <br />Date <br />❑ Developer Agreement ❑ Engineer's Report On Improvement Petition <br />❑ Engineering Agreement ❑ Engineering Service Work Request <br />❑ Public Improvement Permit Application ❑ Map or Drawing <br />WHITE/Finance YELLOW/ Administration File PINK/ Engineering File GOLDENROD/ Project Manager April 2010 k <br />