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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): M Dianne Cunningham Trust Address: 1072 W Broadway St City/State/Zip Signature: Eugene, OR 97402 APPLICANT ❑ / APPLICANT'S REPRESENTATIVE ❑ (CKecl< one): Name (print): Company/Organization: Address: City/State/Zip: Phone: Signature: Phone: See Designated Contact Person E-mail (if applicable): Fax: APPLICANT'S REPRESENTATIVE Q / DESIGNATED CONTACT PERSON Q (Check all that apply): Name (print): Katie Keidel, Associate Planner Company/Organization: Metro Planning, Inc. Address: 846 A Street City/State/Zip: Spfld,OR 97477 Phone: (541) 302-9830 Signature: E-mail (If applicable): kkeidel@metroplanning.com Fax: www.eugene-or.00v/plannino Planning & Development v Updated: September 2024 Planning Division 99 W. 10T" Avenue Suite 290, Eugene, OR 97401 Phone: 541.682.5377 or E-mail: planningCcDeugene-or.aov Page 4 of 4