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? ❑■ Yes / ❑ No): <br />Name (print): <br />Todd Matthews <br />Address: 2545 Potter Street <br />city/State/zip: Eugene, OR 97405 <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 />Phone: 541.517.3399 <br />E-mail (if applicable): <br />Fax: <br />Todd Matthews <br />APPLICANT'S REPRESENTATIVE ■❑ / DESIGNATED CONTACT PERSON ❑■ (Check all that apply): <br />Name (print): carol schlrmer <br />Company/Organization: Schirmer Consulting, LLC <br />Address: PO BOX 10424 <br />city/State/zip: Eugene, OR 97440 <br />Phone: 541.234.5108 <br />Signature: <br />Carol Schirmer <br />Planning & Development <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 <br />E-mail (if applicable): schirmer�a schirmerconsulting.com <br />Fax: <br />Digitally signed by Carol Schirmer <br />DN: C=US, E=schirmer@schirmerconsulting.com, CN=Carol Schirmer <br />Reason: I am approving this document <br />Date: 2025.05.20 16:27:21-07'00' <br />www. eugene-or. qov/planninq <br />Updated: December 2024 <br />Page 3 of 3 <br />