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Enter Document Title www.eugene-or.gov/planning Planning & Development Updated: December 2016 Planning Division Updated: September, 2012 99 W. 10TH Avenue, Eugene, OR 97401 Phone: 541.682.5377 or E-mail:eugeneplanning@ci.eugene.or.us Page 3 of 4 By signing, the undersigned certifies that he/she has read and understood the submittal requirements outlined, and that he/sh e 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): Address: Email: City/State/Zip: Phone: Fax: Signature: 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: Signature: Date: SURVEYOR: Name (print): Company/Organization: Address: City/State/Zip: Phone: Fax: E-mail: Signature: Date: