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~ ~3 <br /> City of Eugene <br /> Planning & Development Department <br /> Building & Fermit Services ' <br /> 99 W. 10th Avemte <br /> Eugene, OR 97401 <br /> Customer Information: Billing Information: <br /> <br /> Cuslomer N Company Date <br /> ~ Purchau Ordcr Number (non-City dtpartntents) <br /> Ctry, Statc, Ctry Job Number or Account Code <br /> Customer Telephone Departnunt to be 13il/ed <br /> CantactNanu: In ~i ~ S ~ ~ ~ J~~~ e OV' <br /> ~ ~ • <br /> Quantity Description of Service PIC Revenue Code Amount <br /> ill" ~I I - ~I-~~I -~~~a Coo . ~ <br /> ~~oa <br /> • ~ ~ 4=~~ <br /> Total Due <br /> <br />