A.M <br />City of Eugene Land Use <br />LAND USE RECEIPT <br />DATE 12/6/2016 <br />Method of Payment <br />Customer Information <br />❑ Cash <br />Name Gregory S Brokaw <br />❑ Check <br />Address 1 E Broadway Suite #300 <br />Visa/MC <br />Eugene 97401 <br />Project 1803-0821-05900 <br />Amount Received <br />$597.32 <br />Subtotal App Fees $ <br />Subtotal Other Fees $ <br />Admin Fee (not included on appeal 9% $ <br />Total <br />Staff Receiving Application <br />MHD <br />Building Permit Services • 99 West 10th Avenue • Eugene, Oregon • 97401 • 541-682-5377 <br />