i 0 <br />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): Russell Roll <br />Address: 55 Coburg Road <br />City/State/Zip: Eugene, OR 97401 <br />Signature: <br />APPLICANT ❑■ / APPLICANT'S REPRESENTATIVE ❑ (Check one): <br />Name (print): Patric Campbell <br />Phone: 541-868-0674 <br />Company/Organization: Campbell Commercial Real Estate <br />Address: 777 High Street #00 <br />City/State/Zip: Eugene, OR 97401 <br />Phone: 541-484-2214 <br />Signature: <br />E-mail (if applicable): patricc@campbellre.com <br />Fax: <br />APPLICANT'S REPRESENTATIVE Q / DESIGNATED CONTACT PERSON ❑■ (Check all that apply): <br />Name (print): <br />Shaun Danielson <br />Company/Organization: Boulder Associates Architects <br />Address: 2 Nickerson Street <br />City/State/Zip: Seattle, WA 98109 <br />Phone: 206-590-1370 <br />Signature: J� <br />E-mail (if applicable): <br />Fax: <br />sdanielson@boulderassociates.com <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. eugene-or.gov/planning <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.eov Page 4 of 4 <br />