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PROJECT NUMBER REQUEST Engineering <br /> Public Works <br /> ; ° . City of Eugene <br /> ~j~i~~ 858 Pearl Street <br /> $it~ ? X13 ? ~L ~ .~~.y`..~+r Eugene, OR 97401 <br /> (503) 687-5291 <br /> Job No. <br /> Project title: I h1 C'~/J I~) ~GTd~ _ _ _ G ~Gl~/ ~~Q~ST-/Z/~!J ~A'"% ~-j' <br /> (location and work descdptionj <br /> ~~1`f~FGIJ tc~f~5~ /,~2w~n1 r'.tl~H'y A-iy,~ T(~UOIy sl <br /> ~~j <br /> Project manager /contact /private engineer: ~~IIJ /~C7 STS ~ sCU~{~lLfJI// Gf <br /> ~~GtJ~c ) <br /> PROJECT SCOPE: <br /> Paving: - - _ -Bike lanes /paths: <br /> ~~jj (widrns) ~ , (widrn~ <br /> Concrete walks: '?'OD ~ -Setback /Curbside /Va <br /> (length) ~(widthJ <br /> Sanitary sewer N6 Storm sewer N ~ Landscaping <br /> Signal ~ D Street lights ROW required <br /> New building construction ~O Planning, other Remodel ~d <br /> FUNDING SOURCE? ~OS SAS ~ Q3~~' 9U~I <br /> City ~ Assessments Private Other department <br /> Fed /State /County /FAA fixed) <br /> COMMENTS /SPECIAL PROJECT INFO. /INTERDEPARTMENTAL WORK DESCRIPTION: <br /> ~1elJJ O~i?- l t~ v0 ~S `lt? t~l G ~`~1l C~ <br /> l~ O I(zrv~/U 0L1F Cq <br /> ' ~__~ilrY~c O~~- s~~-T CE~V~1t~c~~-zy~ 7-v1 ~ ~~Ui s~-~~ <br /> APPROVED: a ~ ~j5' ~ G Date ~ Z--- <br /> Project Manager t'~ ~ <br /> Principal Enginee ~ Date <br /> Facilities Manager ~ Date 3 0 <br /> City Engineer Date <br /> FOR USE BY ADMINISTRATION O``NwLY <br /> Capital Project No. a ~~d~~~ ACK ~°~~O 4°3°~~r f~~~ <br /> GL Title ~~~~N C~~/~u~L.%~~ <br /> Assigned by _ = ~ ~ ~ Date ~ ~ S' ~ <br /> Accounting by ~L~-C Date . <br /> ATTACHMENTS: <br /> <br /> ~ ? Budget Estimate ? Developer Agreement ? Engineer's Report On Improvement Petition <br /> ? Engineering Agreement ? Engineering Services Work Request ? Map <br /> ? City Engineer's Initiating Order ? Public Improvement Permit Application <br /> 2/si WHITE /Finance YELLOW /Administration File PINK /Engineering File GOLDENROD /Project Manager <br /> _ <br /> <br />