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 /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />APPLICANT'S REPRESENTATIVE ❑ / DESIGNATED CONTACT PERSON Q (Check all that apply): <br />Name (print): Same as Representative Company/Organization: <br />Address: <br />Phone <br />Signature: <br />City/State/Zip: <br />E-mail: <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 /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Planning & Development Updated: October 2025 <br />Planning Division <br />99 W. 10'" Avenue Suite 290, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail: planningC@eueene-or.eov <br />Page 5 of 5 <br />