Acknowledgment <br />I (we), the undersigned, hereby acknowledge that I (we) have read the above appeal form, understand the requirements for filing an <br />appeal of a planning director decision, and state that the information supplied is as complete and detailed as is currently possible, to <br />the best of my (our) knowledge. <br />APPELLANT: <br />Name (print): ~r=~~~~ _ Pr nc. <br />Company/Organization: iJsy 2Et_ 14~Ll. /A►-~~ ; u T t ZE J S <br />Address: Z4-60 LA,)eGL UtL~ 7RI'JE <br />iz-:(JCIWF- , CAZ 1-74-03 <br />APPELLANT'S REPRESENTATIVE: <br />Name (print): <br />Company/Organization: <br />Address: <br />City/State/Zip: E-mail (if applicable): <br />Phone: Fax: <br />Signature: <br />IF this appeal is being filed by the affected recognized neighborhood association, complete the following: <br />Name of Association: <br />LA'Qr--C- Lou- ,JAL-L- E-, C kTI ?_cN.5 <br />www. eugene-or.gov/planning <br />Planning & Development <br />Planning Division <br />99 W. le Avenue, Eugene, OR 97401 <br />P 541.682.5377' F 541.685.5572 <br />Updated: October, 2012 <br />Page 2 of 2 <br />