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PROJECT AUTHORIZATION FORM Public Works <br />Engineering <br />Job #: A%52— <br />City of Eugene <br />99 E. Broadway, Suite 400 <br />Eugene, Oregon 97401 <br />(541) 682 -5291 <br />Project Title: t3 � � � _ ��i P� 14bj11- ,l Ol� -- - - - - -- <br />( location and work description) <br />Contact / Private Engineer: <br />PROJECT SCOPE: <br />Paving <br />Concrete <br />(widths) <br />I (length) (width), <br />Wastewater _ - - - -- Stormwater <br />Signal — _---- - - - - -- Street lights — <br />New building construction - - -__ Planning, other <br />Other <br />FUNDING S U E C eck ALL applicable funding sources (% fixed) <br />Cit sessr4 nts - - - -__ Private __ - - - -- Bond <br />Fed_ - -® State ---- _ - - - -_ County - -_ -- FAA_ <br />Account codes <br />Bike lanes / paths —_ <br />(width) <br />Setback / Curbside <br />Landscaping <br />ROW required <br />Remodel <br />Other Dept. <br />Grant <br />APPROVED: <br />Project Manager -- — — - <br />- - - -- - - - -- Date <br />Principal Engineer - -- <br />- - - - - -_ Date I L — <br />Other Manager ----------- <br />- - - -_— - -_ Date-- - - - - - _ - -- <br />City Engineer <br />-- Date_ " �_ <br />FOR USE BY ADMINISTRATION ONLY <br />Capital Project No. -- ' 5 S - - - - - -- AC b 3 -_93 32– Ze xx ! - - - -- <br />GL Title <br />Assigne <br />Accounting by_ -- _ - -- - - - - -- Date_ - -- — <br />SID --j%_ PB - -1 GL V— JC_ JE `n <br />ATTACHMENTS: <br />Project 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 ❑ Map or Drawing <br />❑ Request for Scoping Meeting <br />WHITE/Finance YELLOW/ Administration File PINK/ Engineering File GOLDENROD/ Project Manager April 2010 <br />COMMENTS / SPECIAL PROJECT INFO. / INTERDEPARTMENTAL WORK DESCRIPTION: <br />