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E JECT AUTHORIZATION FORM <br />Public Works <br />Engineering <br />Job #: <br />(widths) <br />Project Title: b-Ep T R E k <br />(location and work description) <br />Project Manage / Contact / Private Engineer . TL �'� 1 �� alt! CD <br />PROJECT SCOPE: <br />Paving _ <br />Concrete walks <br />(length) <br />Wastewater <br />Signal <br />City of Eugene <br />99 E. Broadway, Suite 400 <br />Eugene, Oregon 97401 <br />(541) 682 -5291 <br />Bike lanes / paths_ <br />(width) <br />Setback / Curbside <br />(width) <br />Stormwater Landscaping_ <br />Street lights _ ROW required <br />New building construction Planning, other _ <br />Other Ti o JZ,�i�T' f ILA. E- L- i � NNT t Ii N <br />Remodel <br />FUNDING SOURCES: Check ALL applicable funding sources (% fixed) <br />Cit Assessments Private Bond _ Other Dept. <br />Fed State County _ FAA Grant _ <br />Account codes C 42 - 5212- (v <br />_ � <br />COMMENTS / SPECIAL PROJECT INFO. / INTERDEPARTMENTAL WORK DESCRIPTION: <br />APPROVED: <br />Project Manager Date 2-0 <br />Principal Engineer Date ° <br />oc <br />Other Manager Date <br />City Engineer Dat <br />FOR USE BY ADMINISTRATION ONLY <br />Capital Project No. _g ® f _ ACK <br />GL Title -_� -/ - - -- - - - - -- <br />Assigned by' <br />Accounting by <br />SID V PB <br />5, <br />GL V JC V JE il!!� V <br />Date <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 5k Map or Drawing <br />❑ Request for Scoping Meeting <br />WHITE/Finance YELLOW /Administration File PINK/ Engineering File GOLDENROD/ Project Manager April 2010 <br />