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? 0 Yes/ [j] No): <br />Name (print): Chambers Investors LLC <br />Address: 800 Willamette St Ste 750 <br />City/State/Zip: Eugene, OR 97 401 1 • <br />Signature: YliAfll✓~ <br />APPLICANT Ii] / APPLICANT'S REPRESENTATIVE O (Check one): <br />Phone: _5 _~_1/_,3_3 _g _; '&_3 _c3~Lf __ _ <br />Name (print): _J_e_ff_P_a_r_ke_r __________________________ _ <br />C lo . t· Blackhawk LLC I Parker Development NW ompany rganiza ion: ________________________________ _ <br />Address: 1800 Blankenship Rd <br />City/State/Zip: West Linn, OR 97068 <br />Phone: 503-807-8852 <br />Signature: frh /J~ <br />E .1 (·t 1. bl l jeff@blackhawkd.com -maI 1 app Ica e : ___________ _ <br />Fax: ----------------- <br />APPLICANT'S REPRESENTATIVE Ii]/ DESIGNATED CONTACT PERSON Ii] (Check all that apply): <br />N ( . tl Colin McArthur, AICP ame prin : ___________________________________ _ <br />Company/Organization: Cameron McCarth Y <br />Address: 160 E Broadway <br />City/State/Zip: Eugene, OR 97 401 <br />Phone: 541 -485-7385 <br />cmcarthur@cameronmccarthy.com <br />E-mail (if applicable): ___________ _ <br />Fax: ----------------- <br />Signature: ____________________________________ _ <br />Planning & Development <br />Planning Division <br />99 W. 1QTH Avenue Suite 290, Eugene, OR 97401 <br />Phone : 541 .682 .5377 or E-mail : planning@eugene-or .gov <br />www.eugene-or.gov/planning <br />Updated: May 2024 <br />Page 6 of 6