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<br />Map Information <br />Provide 3 copies upon initi.a.l ~ubn1itt~l. Fo.llowirig completeness review, submit 7 copies. <br /> <br />..~ <br />~. <br /> <br />A map. indicating the propeity involved iri the request and sh~wi~g adjacent.streets, 'alleys, etc. <br />See attached'. . <br />A'vicinity map showing the gene~al area of the request and indicating the specific property involyed <br />in the request. " <br />.See attached. <br />Lel!al DescriDtion <br /> <br />!ZI A legal description for each existing lot involved in the requested change. 'This description mu:st be <br />typed and suitable for recording. '. ' <br />See attached. <br />By signing, the undersigned certifies that he/she has read and understands the submittal r~quirements <br />outlined herein, and that. be/she understands that omission of any listed item,may caus~ delay.in <br />pro.cessing this appli~ation. I (We) the undersigned acknowledge that the information suppli~d in this <br />application is complete' and accurate to the best of my (our) knowledge. <br /> <br />PROPERTY OWNER. <br />State of Oregon Department of Administrative Services <br />. Name (print): William Foster, Administrator' Phone: '503-318-2f~xt 25~~ <br /> <br />Addr~ss: 155 Cottage Street .NE <br /> <br />S.alein, OR 97301 <br />. <;;ity/StatelZip: , <br />.~~ <br /> <br />Signature; <br /> <br />APPLICANT'S REPRESENTATIVE <br /> <br />Name (print): <br /> <br />James w. Spicke~an <br /> <br />Company/Organization: <br /> <br />Gle~ves Swearingen Potter & Scott, LLP <br /> <br />Address: <br /> <br />P.O. ,Box 1147 <br /> <br />City/State/Zip: <br /> <br />Eugene, OR 97440-1147 <br /> <br />Phone: <br /> <br />686-8833 <br /> <br />Fax: <br /> <br />345-2034 <br /> <br /> <br />Signature: <br /> <br />NOTE: This is not a cOInplete list of requirements. ional information may pe required after further <br />review, in ofger to adequately address the required criteria of approval. <br /> <br />Zone Change Application Form <br /> <br />Last Revised: December 31t 2003 <br /> <br />Page 2 of 2 <br />