i <br /> City of Eugene ' <br /> PlanninY & Development Department <br /> BuIIdInE & Permit Services <br /> 99 W. 10th Avenue <br /> Eugene, OR 97401 <br /> Customer Information: Billing Information: <br /> ~-~~oy <br /> <br /> customs. Name/Company Dots <br /> <br /> Address PurcJutse Order Number (non-Ctry departments) <br /> Ctry, Statc, ZJp C!ry Job Number or Account Code ' <br /> P~~ <br /> Customer Telephone Department to be Billed <br /> Contact Nams <br /> ~J.~ ~ Ri ~ ~d ~i,~ <br /> Quantity Description of Service PIC Revenue Code Amount <br /> ~ D . Dd <br /> -l,~ g~ <br /> ,~0 <br /> Total Due <br /> 08- t - <br /> J4H:.~_ i!' ~~~V7 <br /> <br />