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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. I (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): Phone: Address: E-mail (if applicable): City/State/Zip: Signature: APPLICANT❑✓ / APPLICANT'S REPRESENTATIVE ❑ (Check one): Name (print): Sean M. Barnes Company/Organization: Eastmark Capital Group Address: 2212 Queen Anne Ave N #339 City/State/Zip: Seattle, WA 98109 E-mail (if applicable): lean@eastmarkcapitalgroup.com Phone Signature: Fax: APPLICANT'S REPRESENTATIVE ❑ / DESIGNATED CONTACT PERSON ❑ (Check all that apply): Name (print): Company/Organization: Address: City/State/Zip: E-mail (if applicable): Phone: Fax: Signature: www. eugene-or. oov/planning Planning & Development Planning Division Updated: December 2016 99 W. 10T" Avenue, Eugene, OR 97401 Phone: 541.682.5377 or E-mail: plan ning(cDci.eueene.or.us Page 4 of 4