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www.eugene-or.gov/planning Planning & Development Updated: March 2025 99 W. 10TH Avenue, Eugene, OR 97401 Phone: 541.682.8336 or E-mail: landuseinfo@eugene-or.gov Page 5 of 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): ____________________________________________ Phone: ___________________________________________ Address: ___________________________________________________________________________________________________ City/State/Zip: _____________________________________________________________________________________________ Signature: _________________________________________________________________________________________________ APPLICANT / APPLICANT’S REPRESENTATIVE (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: ____________________________________________________________________________________ Address: __________________________________________________________________________________________________ City/State/Zip: ________________________________________ E-mail (if applicable): _______________________________ Phone: _________________________________________________ Fax: ______________________________________________ Signature: _________________________________________________________________________________________________ Note: This is not a complete list of requirements. Additional information may be required after further review in order to adequately address the applicable conditions.