• Planning aWevel-opment <br />Building and Permit Services <br />Receipt Permit and Information Center <br />99 West 10`" Avenue <br />Eugene, Oregon 97401 <br />(541) 687-5086 <br />Method of Payment: Received From <br />O Cash 0 U <br />O Check Address ~J I-A <br />O Visa/MC - Ott ?$O-Z- <br />Phone <br />Amount Received <br />$ ; oo Description/Reference Number: <br />Application Name <br />Application Type 'Application # <br />LAND <br />& 3301 Land Division Application <br />❑ 3302 Land Division Verification Letter <br />❑ 3305 Land Use Appeal <br />O 3300 Land Use Application <br />PLAT <br />❑ 3310 Plat <br />(Final Plat) <br />Post-Monumentation Payments must be made at 858 Pearl St. <br />Date I N-~ U <br />Staff Initials <br />cry OF EUGENE <br />BUILDING & PERMIT SEW .CFI <br />JAN 2, 5 2.001 <br />OFFICE USE <br />P AXID -x353. <br />im E5 <br />LAS}? DIVIS1011 APPLICATi 11 <br />DOCK NASGN RV II ~ C <br />RECEIPT-0 03-[x544819ID <br />REC IV D I I <br />