By signing, the undersigned certifies that he/she has read and understood the s ' ubmittal 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 /F-]No): <br />7 <br />Name (print): Phone: 4f <br />7 <br />Address: ea:0VP, City/State/Zip: ,�''�� �� g��✓" <br />Signature: <br />APPLICANTF—] /APPLICANT'S REPRESENTATIVEfi(Check one): <br />OREGON LICENSED SURVEYOR* (As required under EC 9.8193(1)): <br />*If surveyor has signed the site plans or tentative plat, signature below is not required. <br />Name (print): <br />Company/Organization: <br />Phone: <br />Signature: <br />E-mail: <br />PLS #: <br />www.eu_qene-or.gov ,621anninq <br />Planning & Development Updated: March 2026 <br />Planning Division <br />99 W. 1011 Avenue Suite 290, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail: planning eu ene-or. ov Page 5 of 5 <br />