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:--c TV IA,, wAUT&-7 Wn , Vt n,p04 I~' UC- <br />Name (print): <br />Phone: <br />Company/Organization: <br />Address: ss(; M <br />City/State/Zip: EVI WV G <br />Signature: V V l k V 6W 141M obf-Ky*al- <br />APPELLANT'S REPRESENTATIVE: <br />Name (print): 13 ( u- ~-~0 <br />Company/Organization: V`Av\) [n ` W ~jlut- Me, <br />Address: yv• 4°T+ r- y e -14 <br />l <br />City/State/Zip: E-mail (if applicable): ©Iev 00V (A <br />Phone: `W ( -S-W <br />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.eugene-or.gov/planning <br />Planning & Development <br />Planning Division <br />99 W. 10TH Avenue, Eugene, OR 97401 <br />P 541.682.5377 * F 541.685.5572 <br />Updated: October, 2012 <br />Page 2 of 2 <br />