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, acknowledge <br />that the information supplied in this application is complete and accurate to the best of my (our) knowledge. <br />OWNER (Also the Applicant?, Yes / ❑ No): <br />Name (print): VIA 8Pr(,i k L7*14 Vlt SOU1A%(Al� Phone: <br />Address: 2-IW7 4kvL O SF <br />City/State/Zip: <br />Signature: <br />APPLICANT ❑ / APPLICANT'S REPRESENTATIVE,E(Check one): <br />Name (print): <br />V I L " SkAUL-A V" <br />Eve_%L <br />Company/Organization: bEsr <br />Address: zqb?q V_Euslo S-F <br />City/State/Zip: - r�- q-7Z <br />Phone: 541 2,3 S (PO-3 <br />Signature: <br />iowiht(r <br />54Iz37-3ce 8 3 <br />E-mail (if applicable): IKFDEuC C� � (� • CD <br />Fax: <br />APPLICANT'S REPRESENTATIVE ❑ / DESIGNATED CONTACT PERSON ❑ (Check all that apply): <br />Name (print): 5AVLt, <br />Company/Organization: <br />Address: <br />City/State/Zip: _ <br />Phone: <br />Signature: <br />E-mail (if applicable): <br />Fax: <br />Note: This is not a complete list of requirements. Additional information may be required after further review in order to <br />adequately address the applicable approval criteria. <br />www.eu ene-or. ovplanning <br />Planning & Development Updated May 2024 <br />Planning Division <br />99 W. 10T" Avenue Suite 290, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail:,planning@eugene-or.gov Page 2 of 2 <br />