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www.eugene-or.gov/planning Planning & Development Updated: September 2022 Planning Division Updated: September, 2012 99 W. 10TH Avenue, Eugene, OR 97401 Phone: 541.682.5377 or E-mail: planning@ci.eugene.or.us Page 3 of 3 Note: This is not a complete list of requirements. Additional information may be required after further review in order to adequately address the applicable approval criteria. By signing, the undersigned certifies that he/she has read and understood the submittal requirements outlined, and that he/she understands that omission of any listed item may cause delay in processing the application. I (We), the undersigned, acknowledge that the information supplied in this application is complete and accurate to the best of my (our) knowledge. OWNER (Also the Applicant? Yes / No): Name (print): Phone: Address: City/State/Zip: Signature: OWNER (Also the Applicant? Yes / No): Name (print): Phone: Address: City/State/Zip: Signature: APPLICANT’S REPRESENTATIVE / DESIGNATED CONTACT PERSON (Check all that apply): Name (print): Company/Organization: Address: City/State/Zip: E-mail (if applicable): Phone: Fax: Signature: