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NOTICE STATEMENT: If the Eugene/Springfield Fire Marshall (or the Fire Marshal's designee) determine that there is inadequate water supply, apparatus access, or both, to the site for the development of one and two family dwellings that will be subject to the Oregon Residential Specialty Code, the Eugene Building Official (or the Building Official's designee) may require compliance with one or more of the fire suppression or fire containment Uniform Alternate Construction Standards set out at OAR 918-480- 0125(4) and (5). 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)'-,J/ ii^, j,, � `J Phone: Address: City/State/Zip: Signature: APPLICANT❑ / APPLICANT'S REPR`E!`ENTATIVE ❑ (Check one): Name (print): Company/Organization: Address: City/State/Zip: E-mail (if applicable): Phone: Fax: Signature: APPLICANT'S REPRESENTATIVE/ DESIGNATED CONTACT PERSON�(Check all that apply): Name (print): Company/Organization: ;� t Address: City/State/Zip: �j Cp ,)e�E-mail (if ag'7 licable): Ito , CamVA Hct) , Cc�v� Phone:,'; ``t`t Cj E l� 7531 Fax: Signature: Planning & Development Planning Division 99 W. 10T" Avenue, Eugene, OR 97401 Phone: 541.682.S377 or E-mail: planning@ci.eugene.or.us@ci.eugene.or.us www. eugene-or. gov/p/anninq Updated: December 2023 Page 6 of 6