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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 <br />Name (print):f" otq T. s <br />Address: 1093 be. Email: P-r <2!D k- ilp cool <br />City/State/zip: Yr l t 9-7qqg Phone:,5411.5516 ° 6 Fax• 6-V/ , <br />Signature: Date: 1 /1-1 /1'1 <br />PROPERTY OWNER OF TAX LOT: <br />Signature: Date: 1 /14/19 <br />PROPERTY OWNER OF TAX LOT: <br />Name (print): <br />Planning & Development Updated: December 2U16 <br />Planning Division <br />99 W. JOTH Avenue, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail:eugeneplanning@ci.eugene.or.us Page 3 of 4April 8, 2019, Meeting – Item 2C