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City of Eugene <br /> Planaing & Development Department _ <br /> Building & Permit Services ~ 2 <br /> 99 W. lOdi Avem~e ? <br /> Eugene, OR 97401 <br /> Customer Information: Billing Information: <br /> C,~~ - ~ ~ ~ 3 ~2~ l o ~ <br /> Customer Name/Comparry Dare <br /> 2`~" ~ ~j~ ~ArbtN ~4--~ <br /> <br /> dddress Pwehase Order Number (non-City departments) <br /> Ctry, State, Ztp CtryJob Number or.lccount Code <br /> t <br /> Customs rskphone 1 ' 1 Department to be B!!kd <br /> J~N1 Fes-- W (U-~ >C S 3~ BPS F!~^, ~t 6ti-yaar- ~rSS~o ~-F~~~ .r <br /> Contact Name <br /> Quantity Description of Service PIC Revenue Code Amount <br /> ~ LUGS ,Q~ZoN cP~x-- c,~-~~-NNEi~ ~u~..~tc <br /> I BLS ~tiiA~n~ U ~ ~pAnrE B o ~O'~ • ~o <br /> ~ Lug S A-M~12dnf G~_ ~lt,~{ ~ 1~-~- ~ vt~~1 ~O ~ - ~ 0 <br /> Lu LS M-~2a?~ C17`~ V I~1 ~ t.~brJE c~~ . 8 C~ <br /> '~I.-~ Rla~ ~ <br /> I <br /> Total Due <br /> <br />