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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: xcov <br />Name (print): I(2Iq'Y~~'I J-h_IV koVSL <br />Address: 3(,p&0 51 St 6,2S V (fit j IgVf, Email: (2 65; t"P(j_gV_ <br />City/State/Zip: r7'biCAyA,C, Phone: SN j-q)q_g7eFax: <br />Signature: j (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. 10TH Avenue, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail:eugeneplanning@ci.eugene.or.us Page 3 of 4January 21, 2020, Public Hearing – Item 2Page 137