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 />OWNER (Also the Applicant? E] Yes / ® No): <br />Name (print): Amazon Corner, LLC Phone: Jon Lauch, President, 541-868-3126 <br />Address: PO Box 5935 <br />OR 97405 <br />Signature: <br />/ APPLICANT'S REPRESENTATIVE E] (Check one): <br />6114- <br />Name (print): <br />Company/Organization: <br />Address: <br />City/State/Zip: E-mail (if applicable): <br />Phone: Fax: <br />Signature: <br />APPLICANT'S REPRESENTATIVE DESIGNATED CONTACT PERSON ® (Check all that apply): <br />Name (print): Greg Brokaw <br />Company/organization: Rowell Brokaw Architects, PC <br />Address: 1 East Broadway, Suite 300 <br />City/State/Zip: Eugene, OR 97401 E-mail (if applicable): greg@rowellbrokaW.COm <br />Phone: 541-485-1003 Fax: 541-485-7344 <br />Signature: <br />Note: This is not a complete st f re irements. Additional information may be required after further review in order to <br />adequately address the applicable appro I criteria. <br />www. euoen a-or. oov/plonninp <br />Planning & Development Updated: March 2014 <br />Planning Division <br />99 W. 10'" Avenue, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail:eugeneplanning@ci.eugene.or.us Page 3 of 3 <br />