Laserfiche WebLink
By signing, the undersigned certifies that he/she has read and understood the submittal requirements outlined, andehet Fie/she <br />understands that omission of any listed item may cause delay in processing the application. I (We), the undersigned, <br />acknowledge that the information supplied in this application iscompleteand accurate to the best of my (our) knowledge. <br />PROPERTY OWNER OF TAX LOT: _01 _ <br />kv, <br />Name (print):J oJ <br />Address: N Email: CAN d 1 <br />L� C ��] <br />City/State/Zip: LN�kQJj1�� l U Phone:5-41-� V F�a�4: <br />Signature: MVv'1 _0� Date: <br />PROPERTY OWNER OF TAX LOT: 0_'' N —1 H -- 003 <br />Name (print): <br />Address: <br />i <br />City/State/Zip: b <br />- Signature:�M�A(n Q_,(/I/1 _ <br />PROPERTY OWNER OF TAX LOT: <br />Name (print): <br />Email: rej' <br />y -\o5hwcl. -'k oc/ 0,�yv"') .cam <br />Phone <br />Date: � <br />Address: Email: <br />City/State/Zip: Phone: Fax: <br />Signature: Date: <br />SURVEYOR: <br />Name(print): <br />IJ <br />Company/Organization: r_„��v�tiiv�nc, -L <br />Address: <br />City/State/Zip:Sy Y� ' j q Phone: 5y I _'7%-CLAIX: <br />E-mail:Lj <br />yQ n¢.l GC �A►�G��y��,iy�eJt vy`Q, . C-oY+n <br />Signature:�Z�� C f. Date: 1111911e <br />Planning & Development Updated: March 2014 <br />Planning Division <br />99 W. 10" Avenue, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail:eugeneplanning@ci.eugene.or.us Page 3 of 4 <br />