By signing, the undersigned certifies that he/she has read and understood the submittal requirements outlined, and that he/she <br />understands that omission of any listed item may cause delay in processing the application. I (We), the undersigned, acknowledge <br />that the information supplied in this application is complete and accurate to the best of my (our) knowledge. <br />OWNER (Also the Applicant? [�Kes / ❑ No): <br />Name (print) <br />L"v,, M, t-e <br />Phone: <br /> <br /> <br /> <br />APPLICANT ❑ / APPLICANT'S REPRESENTATIVE ❑ (Check one): <br />Name (print): <br />Company/Organization: <br />Address: <br />City/State/Zip: <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): <br />Company/Organization: <br />Address: <br />City/State/Zip: <br />Phone: <br />Signature: <br />E-mail (if applicable): <br />Fax: <br />Note: This is not a complete list of requirements. Additional information may be required after further review in order to <br />adequately address the applicable approval criteria. <br />www.euGene-or.gov/plonninp <br />Planning & Development Updated May 2024 <br />Planning Division <br />99 W. 10T" Avenue Suite 290, Eugene, OR 97401 <br />Phone: 541.682.5377 or E-mail: planning@eugene-or.gov Page 2 of 2 <br />