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i <br /> City of Eugene <br /> Plannir~ & Development Department <br /> Buildfng & Permit Services <br /> 99 W. 10th Avenue <br /> <br /> Eugene, OR 97401 <br /> Customer Information: Billing Information: <br /> ~1' ~ <br /> Customer Name/Company Dats <br /> .lddress Purchase Order Number (non-Ctry departments) <br /> Ctry, State, Ztp Ctry Job Number oc Account Code <br /> ,ZYI d~' <br /> Customer Telephone Department to 6e Btlled <br /> Contact Name <br /> Quantity Description of Service PIC Revenue Code Amount <br /> I Q v <br /> u~ <br /> V <br /> G G-. 2 4 A 0 ~ i 7 R C V S Total Due <br /> <br />