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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. PROPERTY OWNER OF TAX LOT: 900 Name (print): Daniel Force Address: 615 E. 46th Avenue Email: forcehomesllc@gmail.com City/State/Zip: Eugene, OR 97405 Phone: 541.206.3366 Fax: Signature: Date: 3.19.23 PROPERTY WNER ANTI OT. Name (print): Address: Email: City/State/Zip: Phone: Fax: Signature: Date: PROPERTY OWNER Of TAX MT. Name (print): Address: Email: City/State/Zip: Phone: Fax: Signature: Date: SURVEYOR: Name (print): Kent Baker Company/Organization: Roberts Surveying, Inc. Address: 2811 Lydick Way City/State/Zip: Eugene, OR 97401 Phone: 541.345.1112 Fax: E-mail: kent obertssurvey.com Signature: Date: 3.19.23 Planning & Development Planning Division 99 W. 10T" Avenue, Eugene, OR 97401 Phone: 541.682.5377 or E-mail:eugeneplanning@ci.eugene.or.us Updated: December 2016 Page 3 of 4