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 />Naone i crir: is <br />Company/Organization: 4 JS~ i~EL t-1 ~ L~ ~l~s LE`; C~ T 1 Z~ }J $ <br />Address: Wu- 17~1u~ <br />City/State/Zip: i=y C' E I i ~ 7 +-03 <br />APPELLANTS 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 />www. a ugene-or, gov/planning <br />Planning & Development <br />Planning Division <br />99 W. 10rk Avenue, Eugene, OR 47401 <br />P 541.682.5377 " F 541.685.5572 <br />Updated; October, 2012 <br />Page 2 of 2 <br />Laurel Ridge Record (Z 15-5) Page 34 <br />