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PROJECT AUTHORIZATION FORM <br />\A <br />o ` <br />Job #: <br />Project Title: _ � d T - 1 1be <br />(location and work description) <br />Public Works <br />Engineering <br />City of Eugene <br />99 E. Broadway, Suite 400 <br />Eugene, Oregon 97401 <br />(541) 682 -5291 <br />Project Manager / Contact / Private Engineer: <br />PROJECT SCOPE: <br />Paving <br />(widths) <br />Concrete walks _ <br />(length) (width) <br />Wastewater Stormwater <br />Signal Street lights <br />New building construction Planning, other <br />Other <br />Bike lanes / paths <br />(width) <br />Setback / Curbside <br />Landscaping <br />ROW required <br />Remodel <br />FUNDING SOURCES: Check ALL applicable funding sources (% fixed) <br />City Assessments Private Bond . Other Dept. <br />Fed_ State _ _ County` Grant <br />Account codes — <br />COMMENTS / SPECIAL PROJECT INFO. / INTERDEPARTMENTAL WORK DESCRIPTION: <br />°P WE `i ASc,t % ►" pre - m r) avg id 4ed 4 r. c--f ti <br />°fib �� �n5 ,� � •-�+s ,� '� � 1 �" �� .2. "i" �°�-�° s�r � <br />APPROVED: j_� <br />Project Manager W� Date � -E& "" I Z <br />Principal Engineer Date <br />Other Manager _ Date dd <br />City Engineer Date "6Z���� <br />FOR USE BY ADMINISTRATION ONLY <br />Capital Project No. q� <br />GL Title _ <br />Assigned by <br />Accountin g by / <br />SID V / PBo "GL V — JC_ <br />ATTACHMENTS: <br />ACK _ 510' 35t(-- leX/X>e <br />JE 01 7 - 6-4 <br />Project Budget Summary ❑ Developer Agreement <br />❑ SDC Budget Worksheet ❑ Engineering Agreement <br />❑City Engineer's Initiating Order ❑ Public Improvement Permit Application <br />❑ Request for Scoping Meeting <br />Date <br />❑ Engineer's Report On Improvement Petition <br />L) Engineering Service Work Request <br />❑ Map or Drawing <br />WHITE/Finance YELLOW/ Administration File PINK/ Engineering File GOLDENROD /Project Manager April 2010 <br />