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CIty of Eugene ~ <br /> Planning & Development Department <br /> Building & Permit Services <br /> 99 W. 10th Avenue <br /> <br /> Eugene, OR 97401 <br /> <br /> Customer Information: Billing Information: <br /> l I~l ~ ~le-t-4~~5 fl >J ~O` ~ ` ~ <br /> <br /> Customer Namt/Comparry Dots <br /> CC o~ ~v~,~l~ Q~rz.rs ~ o~~•l - - <br /> Sp~c.E- ~~V'- <br /> Address Purchass Order Numbar (non-City departments) <br /> ~E D~ ~~~ol N $ o <br /> Gry, State. Ztp Ciry Job Nwnbsr w Account Code <br /> (o'$ 2 - ~ O ~ ~iMZKS ~ O~ETJ S ~AC,E 'Dl V"l S r ol~l <br /> Customer Te%phons Department to bs Billed <br /> f L.(~ r2.1~-F~,4ri2.p SO l~ <br /> contact Nmne <br /> Quantity Description of Service PIC Revenue Code Amount <br /> LV G S 14 ~~X DI,cJ,~1-T~72 ~o `f' $ ~ <br /> 7KA~t L PTto J E crT- <br /> . '~PA I.ESS~q ~ d ~'~•VL L ¢,o c.lUk Ao >e~T" <br /> -g S'S~o -o --42.2. ~ <br /> l Co Z- 3Z + "9 33s -agS Z <br /> . ~ C7 <br /> Total Due <br /> <br />