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PROJECT AUTHORIZATION FORM <br />Service ID: <br />Project Title: <br />(location and work <br />ar~- <br />SU~- - <br />SID PB GL JC JE _ <br />din v Imo[ T-vm.S is [ N <br />Public Works <br />Maintenance & <br />Parks and Open Space <br />City of Eugene <br />1820 Roosevelt Boulevard <br />Eugene, Oregon 97402 <br />(541) 682-4800 <br />(541) 682-4882 FAX <br />www.eugene-or.gov/parks <br />Project Manager/Contact/Private Engineer: R_l-(f~F lz-[ <br />PROJECT SCOPE: <br />Paving: <br />(widths) <br />Concrete walks: (length) (width) <br />Wastewater Stormwater <br />Signal Street lights <br />New building construction anning, they <br />Bike lanes/paths: <br />(width) <br />Setback/Curbside <br />Landscaping <br />ROW required <br />Remodel <br />FUNDING SOURCES: <br />City os N'.t> Assessments <br />Account Code <br />Fed / State / Count / FAA <br />COMMENTS / SPECIAL PROJECT INF, <br />INTERDEPARTMENTAL WORK DESCRIPTION: <br />Or0c` <br />fixed) <br />APPROVED: <br />P)1414A N1 15, t b - Project Manager: Date: I <br />Section Manager: Date: 3 ' <br />Financial Analyst: Date: <br />Division Manager: Date: <br />-I FOR USE BY ADMINISTRATION ONLY `110 <br />[7~ <br />Capital Project' No. q -15' Z ACK .322 9W3 &w" q7~ Z <br />GL Title t~'l 169 e t° 5~ I L ~IJLTl~ kA P10- ,n l nA <br />Assigned <br />Private Other Department <br />Date: 5 <br />Date: <br />ATTACHMENTS: <br />❑ Budget Estimate ❑ 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 <br />❑ Request for Scoping Meeting <br />PWWPOS 100 WHITE/Finance YELLOW/PW Administration File PINK/Division File GOLDENROD/Project Manager July 2006 <br />