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By signing, the undersigned certifies that he/she has read and understood the submittal requirements outlined, and that he/she understands that omission of any listed item may cause delay in processing the application. 1 (We), the undersigned, acknowledge that the information supplied in this application is complete and accurate to the best of my (our) knowledge. OWNER (Also the Applicant? Yes / ❑ No): Name (print):John Tokatly Phone: (541) 684-7868 Address: 91302 N Coburg Industrial Way City/State/Zip Coburg, OR 97408 Signature: APPLICANT❑ / APPLICANT'S REPRESENTATIVE F,/1 (Check one): Name (print): Richard M. Satre, AICP, ASLA, CSI Company/Organization:The Satre Group Address: 375 West 4th Avenue, Suite 201 p:Eugen?, OR 97401 E-mail (if applicable): rick@satregroup.com (541) 68f(-4540 /-N Phone: : r 'j ,1 _ Fax Signature: APPLICANT'S REPRES ATIVE❑ / DESIGNATED CONTACT PERSON ❑ (Check all that apply): Name (print): Company/Organization: Address: City/State/Zip: E-mail (if applicable): Phone: Fax: Signature: wwiy~errgene-ar,.q~y~~~lr~r~r~r Planning & Development Updated: March 2014 Planning Division 99 W. 10TH Avenue, Eugene, OR 97401 Phone: 541.682.5377 or E-mail: eugeneplanning@ci.eugene.or.us Page 3 of 3