By signing, the undersigned certifies that he/she has read and understood the submittal requirements <br />outlined, and that he/she understands that omission of any listed item may cause delay in processing the <br />application. I (We), the undersigned, acknowledge that the information supplied in this application is <br />complete and accurate to the best of my (our) knowledge. <br />OWNER (Also the Applicant? ❑ Yes / © No): <br />Name (print): Michael P. Dwyer <br />Address: 1115 SE 164th Ave <br />City/State/Zip: Vancouver, WA 98683 <br />Signature: <br />c/o PeaceHealth phone: 360-729-1000 <br />APPLICANT © / APPLICANT'S REPRESENTATIVE ❑ (Check one): <br />Name (print): <br />W. Christopher Hart <br />Company/Organization: <br />The Mark at Eugene, LLC <br />Address: <br />315 Oconee Street <br />City/State/Zip: Athens, Georgia 30601 <br />Phone: <br />Signature: <br />E-mail (if applicable): <br />Fax: <br />APPLICANT'S REPRESENTATIVE ] / DESIGNATED CONTACT PERSON ] (Check all that apply): <br />Name (print): Kristen Taylor or Zach Galloway <br />Company/Organization: TBG Community Planning Group <br />Address: PO Box 10248 <br />City/State/Zip: Eugene, Oregon 97440 <br />Phone: 541.687.1010 <br />Signature: <br />E-mail (if applicable).ktaylor@tbg-arch or <br />zgaiioway@tbg-arch.com <br />Fax: <br />Note: This is not a complete list of requirements. Additional information may be required after further <br />review in order to adequately address the applicable conditions. <br />www.eugene-or. goy/planning <br />Planning & Development Updated: March 2025 <br />99 W. 10T" Avenue, Eugene, OR 97401 <br />Phone: 541.682.8336 or E-mail: landuseinfo@eugene-or.gov Page 5 of 5 <br />