Laserfiche WebLink
By signing, the undersigned certifies that he/she has read and understood the submittal requirements outlined, and that he/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 is complete and accurate to the best of my (our) knowledge. <br />PROPERTY OWNER OF TAX LOT: ClJ <br />Name (print): A Lae <br />Address: 1,561-Email: C~ V / I [~~`~'I Y LC L <br />City/State/Zip:q /Phone: 1--~ ^F :0 -72 - <br />Signature: 1 Date: <br />PROPERTY OWNER OF TAX LOT: <br />Name (print): <br />Address: Email: <br />City/State/Zip: Phone: Fax: <br />Signature: Date: <br />PROPERTY OWNER OF TAX LOT: <br />Name (print): <br />Address: Email: <br />City/State/Zip: Phone: Fax: <br />Signature: Date: <br />SURVEYOR: <br />Name (print): <br />Company/Organization: <br />Address: <br />City/State/Zip: Phone: Fax: <br />E-mail: <br />Signature: Date: <br />Planning & Development Updated: December 2016 <br />Planning Division <br />99 W. JOT" Avenue, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail:eugeneplanning@ci.eugene.or.us Page 3 of 4November 13, 2018, Meeting – Item 3C