www.eugene-or.gov/planning <br />Planning & Development Updated:  October, 2012  <br />Planning Division  <br />99 W. 10TH Avenue, Eugene, OR 97401  <br />P 541.682.5377 * F 541.685.5572 Page 2 of 2  <br />Acknowledgment  <br />I (we), the undersigned, hereby acknowledge that I (we) have read the above appeal form, understand the requirements for filing an  <br />appeal of a planning director decision, and state that the information supplied is as complete and detailed as is currently possible, to  <br />the best of my (our) knowledge.  <br />APPELLANT:  <br />Name (print): Phone:  <br />Company/Organization:  <br />Address:  <br />City/State/Zip:  <br />Signature:   <br />APPELLANT’S REPRESENTATIVE:  <br />Name (print):  <br />Company/Organization:  <br />Address:  <br />City/State/Zip: E‐mail (if applicable):  <br />Phone: Fax:  <br />Signature:   <br />IF this appeal is being filed by the affected recognized neighborhood association, complete the following:  <br />Name of Association:        <br />Jefferson Westside Neighbors <br />Ted Coopman, Chair <br />101 W. 10th Ave. <br />Eugene, OR 97401 <br />Jefferson Westside Neighbors <br />Jefferson Westside Neighbors <br />Eugene, OR 97402 Jefferson Westside Neighbors <jwneugene@gmail.com> <br />206.214.8625 <br />See Representative, below <br />971 W Broadway