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- - ~ t. <br />Pu~li~ ~V~rks <br />~~~li~a~l~~ for Publ~~ I~~r~v~n~~n# ~'ermi~ En~i~~ering <br /> <br />/ ~ City of Eagerte ,fob Number ~ ~ ~ Contract Nc~m~er <br />E, ~rQadway, Site 400 f . f~agene, 4regar~ 97401 _ <br />. i ~~~1 } G~~-529 <br />{a41 } ~8~-5p3 FAk <br />! _ Ulfhereby make appficakion far a ~UB~lC fi~1PR~1~EM~NT P~Ri~~T to canstruot public improvements E <br />(awrrer) <br />in the pui~lic way, as described below: <br />Type of improvement; P~Virtg ~I~d 5tarm Dr~ln~ge ~ f <br />(Paving, wasfewatsr, stormwa~er, street lrghls.~ <br />l~ocatian. ~~11~rd Street and Orchard All~e~ <br />(Sfreef or easement work is ~i~lain or subdiUision name) <br />i <br />~ar~h - N bour~da ~f lot 5000 5ou~h - ~ ~our~d~r o~ I~~ 400 ` North for east} limit: _ .,,,,,,,..,..r South for west} limit. ~ <br />in strict conformance with Giky of Eugene standard specifications far puf~iic improvements ~incl~ding~current addenda}, construction <br />plans approved by the city engineer or his representative, the current edit(an of ~"Procedures far Privately Engineered Projects," khe <br />Eugene Ciky Code, artd the standard and special cvr~ditians printed vn this permit farm, The owr~erlappl(cant is responsible far <br />providing a cagy of this permit to the cvnkractar performing the work. <br />Contact Person sprint} ~e~se ~f~llor, PE Phone Number 541-X84-490 <br />. ~ - <br />. ~ ACRE Billing [nfarmatian. <br />❑ Same ~ Di~erentz see below . PRINT SfGNATU <br />~.tf . i i~ATE CVAM~ <br />~~01 yak St~2e~r Suite 100 C . MAILING ApDRESS BCE.I.iI~G AC)DRESS <br />Eugene, ~R 9?~0~ <br />CITY !STATE ! ~lP....„..w Ck1Y .t STATE l ~1P i~ F <br />.54~,-~~~-4~Q~ S <br />P~#~C~E N~lMSER ~busPness hours } <br />s <br />~~8L1~ ~i~I~R~V~I~~~T PE~MI~' <br />I. Permission is hereby granted to applicant and applicant's contractor to perform the work stated above, in cvr~farmance with ' . <br />conditions listed above, t}efow, ahd an the reverse side of this permit form. - <br />The permit shall be void unless the wank descried herein is completed by: <br />. <br />i • SPECIAL. C~ND1Tf~NS ~ ~ , <br />1; <br />~ i <br />s" 5 a ~ <br />i <br />. . ~rigina~ tyre City o~Fr~~:~ii~ ~ t <br />APPR~VE~: SATE: ~ aity Engineer - - Gopie~ to ~wt?~r: ~~bwtrer:; arrd Ir~s~ector f s <br />• r C <br />- 7 <br />. . . . . <br />