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? lI Yes / E No): <br />Name (print)BYOUNq JIIN P hone St+t-ltr-oq tq <br />Address:21" (x.Vridla ct. <br />City/State/Zip CvLOrf++. ot?1 44o{ <br />Signature Ar- <br />eerltcntr ! / AppucANT's REpRESENTAT|VE E (chect< one) <br />Michael MageeName (print) <br />Company/Orga - _-^,, BDA Architecture and Planning, PCntzatton: <br />1369 Olive StreetAddress: <br />Eugene lORl97401 magee@bdarch.netcity/state/zip <br />541-683-8661Phone: <br />E-mail (if applicable) <br />Fax: <br />Signature Michael Magee ,'!-&{y sqn€d by Mrchrr ME€.I :irNtc.us, E=rus*@earch..d <br />APPLTCANT'S REPRESeTUTTVT E / OTSTGNATED CONTACT CrnSOlt ! (Check all that apply)i <br />Name (print) <br />Company/Organization <br />Address: <br />city/state/zip <br />Pho!e: <br />E-mail (if applicable): <br />Fax: <br />Signature: _ <br />Note: This isnota complete list of requirements. Additional information maybe required afterfurther review in orderto <br />adequately address the applicable approval criteria. <br />Planning & Development <br />Planning Division <br />99 W. 10}rAvenue Suite 290, Eugene, oR 97401 <br />Phone: 541.582.5377 or E-mail: gb!ODg1e9!.9!gg!q4M <br />updated: May 2024 <br />PaBe 3 of 3