By sigmnE. the undersigned certifies that he/she has read and understood the submittal requirements outlined, and that he/she <br />undercta; ds that omission of any listed item may cause delay in processing the application. I (We), the undersigned, <br />acknowledge that the information supplied in this application is complete and accurate to the best of my {our) knowledge. <br />OWNER (Also the Applicant? ftl Yes / 71 No): <br />Marne (print): <br />Address: PO ?_jj - <br />Name (print): <br />Company/Organization: <br />Address: <br />city/state/zip: E-mail (if applicable): <br />Phone: Fax: <br />Signature: <br />APPLICANT'S REPRESENTATIVE ,,N'/ DESIGNATED CONTACT PERSON (Check all that apply): <br />Name (print): <br />Company/Organization: f r-A ~ P< (-4 L <br />Address: ":~J 7 ~r ,b i c 0 A L' <br />4~) -]4C t' _ <br />City/State/Zip: t f+ E-mail (if applicable): 4 { fLL.✓J « ~ fS 'fi'r [E''r"-~ <br />Signature: <br />1~1'.t]fkY~~V!i13'f!s' s!!.~~~iz~r~nir~~ <br />Planning & Development Updated: February 2016 <br />Planning Division <br />99 W 10"' Avenue, Eugene, OR 97401 <br />Phone 541.683.5377 or Email planning@ei.eugene.or.us Page 7 of 7 <br />APPLICANT[] / APPLICANT'S REPRESENTATIVE [j (Check ono): <br />