By signing, the undersigned certifies that he/she has read and understood the submittal requirements outlined, and that he/she <br />understands 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? ❑ Yes / ❑ No): <br />Name (print): Phone: <br />Address: <br />City/State/Zip: <br />Signature: <br />APPLICANT❑ / APPLICANT'S REPRESENTATIVE ❑ (Check one): <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 ❑ / DESIGNATED CONTACT PERSON ❑ (Check all that apply): <br />Name (print): <br />Company/Organization: <br />Address: <br />City/State/Zip: E-mail (if applicable): <br />Phone: Fax: <br />Signature: <br />Note: This is not a complete list of requirements. Additional information may be required after further review in order to <br />adequately address the applicable approval criteria. <br />www. eugene-or. goy/plonninq <br />Planning & Development Updated: March 2014 <br />Planning Division <br />99 W. 10T" Avenue, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail:planning@ci.eugene.or.us Page 3 of 3 <br />