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<br />: " <br /> <br />Written Statement <br /> <br />~. A "vritten statementlisting rel~vant Statewide Planning Goals and demonstrating that the requested change <br />, satisfies the approval criteria in the Eugene Code, Section 9.7739(3). Describe any unchanged portion of the <br />plan your aInenchnent Dlay effect. <br /> <br />S~e attached. <br /> <br />'Information Reauired for ProDosed Plan Text 'Chang:es <br /> <br />~ Map jndic~tingthe property included in the request and' adjacent streets and aUeys', <br />See att~ched. . <br />~ Vicinity map indicating the general area and allowing easy identification of the proPerty. <br />S.ee attached. . <br />Note: This is not,a.complete list of requirements~ 'Additional information may be required after <br />further ,review in order to adequately, address the required criteria of approval. <br /> <br />By signing, the undersigned certifies that he/she has read and understands the submittal' requirements <br />outHnerl herein, and t~at h~she understands that omission of any listed item may.(ause delay in <br />processing this application. I (We) the undersigned acknowledge that the information supplied i.n this <br />application is comp.lete and accurate to the best of my (our) k~owledge. <br /> <br />OWNER (Also the Applicant?~ Yes 10 No): <br /> <br />Nanl~ (print): <br /> <br />State of Oregon Department of Administrative Services <br />William Foster, Administrator Phone: 503-3.78-2855, Ex't. 252 <br /> <br />Address: <br /> <br />155 Cottage Street "NE <br /> <br />City /State/Zip: <br /> <br />Signature: <br /> <br />Salem, OR 97301 <br /> <br />/3;~--, }c~ <br /> <br /> <br />... ~. <br /> <br />APPLICANTD I APPLICANT'S REPRESENTATIV~ ~(Check one): <br /> <br />Name (print): <br /> <br />James W. Spickerman <br /> <br />Company /Organization: <br /> <br />Gleaves Swearingen Potter & Scott LLP <br /> <br />Address: <br /> <br />P.O.' Box 1147' <br /> <br />, 97440-1147 . <br />City/StatelZip: Eugene, OR E-mail (ifapplicable):~pickeziM.n@orbuslaw.com <br /> <br />Phone: 034 <br /> <br />Signature: <br /> <br /> <br />Note: This is complete list of require ditionaJ information may be required after further <br />review in order to adequately address the applicable ap.proval criteria. <br /> <br />Metropolita.fi Plan Amendment <br /> <br />Last Updated: 1/2004 <br /> <br />Page.20f2 <br />