By signing, the undersigned certifies that he/she has read and understood the submittal requirements <br />outlined, and that he/she understands that omission of any listed item may cause delay in processing the <br />application. I (We), the undersigned, acknowledge that the information supplied in this application is <br />complete and accurate to the best of my (our) knowledge. <br />PROPERTY OWNER OF TAX LOT: 600 & 800 <br />Name (print): Spider, LLC, an Oregon Limited Liability Company Phone: q 1 31 - S 1 S Z <br />Address: 1137 Washington Street <br />City/State/Zip: Eugene, OR 97401 E-mail (if applicable): eQ <br />`J <br />lo" <br />PROPERTY OWNER OF TAX LOT: 100 <br />Name (print): 432 LLC, an Oregon Limited Liability Company Phone: <br />Address: 432 West I Vh Avenue <br />City/State/Zip: Eugene, OR 97401 E-mail (if applicable): <br />Signature: ~c m ~g~KG m rn~ <br />SURVEYOR (REQUIRED UNLESS ADJUSTMENT PARALLEL)/DESIGNATED CONTACT PERSON: <br />Name (print): Clell Goodwin <br />Company/Organization: Balzhiser & Hubbard Engineers <br />Address: 100 W. 13`s Avenue <br />City/State/Zip: Eugene, OR 97401 E-mail (if applicable): cgoodwin@bhengineers.com <br />Phone: 541-686-8478 Fax: 541-345-5303 <br />Signature: C~ <br />DESIGNATED CONTACT PERSON <br />Name (print): Clell Goodwin <br />Company/Organization: Balzhiser & Hubbard Engineers <br />Address: 100 W. 13'' Avenue <br />City/State/Zip: Eugene, OR 97401 E-mail (if applicable): cgoodwin@bhengineers.com <br />Phone: Fax: <br />Signature: C ~ <br />Property Line Adjustment Date Last Revised: 12/2003 Page 3 of 3 <br />Application Form <br />