I. <br />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 />i~ vrv ~b HEN <br />Name (print): Phone: ry/ - 3 yy- Q <br />Company/Organization: <br />Address: "7/ Lvc 5T/,j•eoG~ /~Y <br />City/State/Zip: C UGC Q o <br />Signature: <br />r~,4s~ S~ lsJrT/~c E~ Misr o,~ Coo - /~PPc~~~-s <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 />V','WW.eugene"-0i'.gov,/pip- ,nfFifog <br />Planning & Development Updated: October, 2012 <br />Planning Division <br />99 W. 10TH Avenue, Eugene, OR 97401 <br />P 541.682.5377 ' F 541.685.5572 Page 2 of 2 <br />