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? IN Yes / ❑ No): <br />Name (print): Todd Matthews <br />Address: 2545 Potter Street <br />City/State/Zip: <br />Eugene, OR 97405 <br />Phone: 541.517.3399 <br />Todd Matthews <br />Signature: <br />APPLICANT ❑ / APPLICANT'S REPRESENTATIVE ❑ (Check one): <br />Name (print): <br />Company/Organization: <br />Address: <br />City/State/Zip: <br />Phone: <br />Signature: <br />E-mail (if applicable): <br />Fax: <br />APPLICANT'S REPRESENTATIVE ❑■ / DESIGNATED CONTACT PERSON FE] (Check all that apply): <br />Name (print): <br />carol schirmer <br />Company/organization: Schirmer Consulting, LLC <br />Address: PO Box 10424 <br />City/State/Zip: Eugene, OR 97440 <br />Dk­ - 541.234.5108 <br />Signature: <br />E-mail (if applicable): <br />Fax: <br />schirmer@schirmerconsulting.com <br />www.euaene-or.aov/planning <br />Planning & Development Updated: December 2024 <br />Planning Division <br />99 W. 10T" Avenue Suite 290, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail: planning@eusene-or.gov Page 3 of 3 <br />