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 hearings official or historic review board decision, and state that the information supplied is as complete and detailed as <br />is currently possible, to the best of my (our) knowledge. <br />APPELLANT: <br />Name (print): i~/~F} C2~L ~E~ Y -7 l _ <br />~ <br />/~~2SORJS Phone: '777, <br />All" <br />L~l C>/ !L2i J"/ EELS' <br />Company/Organization: D if iiljw JT' .~1~/6H~Z><IS SSaG~.4-r/ <br />Address: a ,SIG % E S 7- <br />APPELLANT'S REPRESENTATIVE: <br />Name (print): 47-, Q1C/lJ,,-r-r AT <br />Company/Organization: <br />Address: /4- 7-Z ZC,~ <br />City/State/Zipi E-mail (if applicable): fio14,44-V . 6bx~ <br />Phone: ?/q V.- <br />Signature: <br />IF this appeal is being filed by the affected recognized neighborhood association, complete the following: <br />Name of Association: ~LJ~LnL ~il_L Vf1 <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 />