Agenda Packet 9-9-19 Meeting - Laserfiche WebLink

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By signing, the undersigned certifies that he/she has read and understood the submittal requirements outlined, and that he/she understands that omission of any listed item may cause delay in processing the application. I (We), the undersigned, acknowledge that the information supplied in this application is complete and accurate to the best of my (our) knowledge. PROPERTY OWNER OF TAX LOT: Name (print): CQiMC, ' K='_ Address: r L, P~L Email: City/State/Zip: ltk-oo ~ - Phone: Fax: Signatur Date: PROPERTY OWNER OF TAX LOT: Name (print): Address: Email: City/State/Zip: Phone: Fax: Signature: Date: PROPERTY OWNER OF TAX LOT: Name (print): Address: Email: City/State/Zip: Phone: Fax: Signatu re: Date: SURVEYOR: Name (print): Company/Organization:t.g° I s i Address:;_ . City/State/Zip: Phone: ` Fax: ~5 E-mail: Signature Date: _ i Planning & Development Updated: December 2016 Planning Division 99 W. 10TH Avenue, Eugene, OR 97401 Phone: 541.682.5377 or E-mail:eugeneplanning@ci.eugene.or.us Page 3 of 4September 9, 2019, Meeting – Item 2C