Planning & Development <br />Planning Division <br />99 W. 10 <br />TH Avenue Suite 290, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail:planning@eugene-or.gov <br />Updated: May 2024 <br />Page 4 of 4 <br />REPRESENTATIVE (IfdifferentfromSurveyor): <br />Name (print): ________________________________________________________________________________________________ <br />Company/Organization: _______________________________________________________________________________________ <br />Address: ____________________________________________________________________________________________________ <br />City/State/Zip: ___________________________________________ E-mail (if applicable): ________________________________ <br />Phone: _________________________________________________ Fax: ______________________________________________ <br />Signature: __________________________________________________________________________________________________ <br />**Attached additional sheets ifnecessary. <br />.DWLH.HLGHO$VVRFLDWH3ODQQHU <br />0HWUR3ODQQLQJ,QF <br />$6WUHHW <br />6SIOG25 <br />   <br />NNHLGHO#PHWURSODQQLQJFRP <br />______________ <br />______________