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 />By signing, the undersigned certiftes 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. | (We), the undersigned, acknowledge <br />that the Information supplied tn this application Is complete and accurate to the bast of my (our) knowledge. <br />OWNER (Also the Applicant? [) Yes / (il) No): <br />Haven and Mallory Beebe = Name (print): id Phone: (alH = 535 -—1W7T11 <br />3050 Bailey Hill Road <br />Eugene, OR 97402 <br />City/State/2ip: 2 OR rate fea L <br />Signature: Ms o : Beaty _ A (a DQ —— <br />APPLICANT [_] / APPLICANT’S REPRESENTATIVE (I) (Check one): <br />See below. <br /> <br />Address <br /> <br /> <br /> <br />Name (print): <br /> <br />Company/Organization: <br />Address: <br /> <br />City/State/Zip: E-mail (if applicable): <br />Phone: Fax: <br />Signature: <br />APPLICANT'S REPRESENTATIVE [Il] / DESIGNATED CONTACT PERSON [Bl] (Check all that apply): <br /> <br /> <br /> <br /> <br /> <br />Zack P. Mittge <br />Name (print): Hutchinson, Cox <br />Company/Organization: 940 Willamette St., Ste 400 <br />Address: Eugene, OR 97401 zmittge @eugenelaw.com <br />City/State/Zip: E-mail (if applicable): <br />(541) 686-9160 (541) 343-8693 <br />Phone: Fax: <br />Signature: K— <br /> <br /> <br />www,eurene-or.cov/planning enema <br />Updated: January 2025 Planning & Development <br />Planning Division <br />$9 W. 10™ Avenue Suite 290, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-matl: planning @euaeps-or.gov Page 3 of 3