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~ <br /> City ~ gene <br /> Planaing & Development Department ~ Z ~ ~ ~ O'~ . <br /> Building & Permit Services - ~ <br /> 99 W. 10th Avenue <br /> Eugene, OR 97401 <br /> Customer Information: Billing Information: <br /> Jo h.n C~~ - ~ -d s'' <br /> Customer NamdCompany - <br /> Date <br /> dddress <br /> Pureiaase Order Number (non-Clry departments) <br /> ~lry Stale. Zlp _ USN ~f OD 3 <br /> Cfry Job Number or Account Code <br /> X 8 3 PGc~ ~ hee~ Y~- <br /> Customer Te%phone <br /> Department to be BiJle <br /> <br /> Contact Name <br /> Q"az't'n' Description of Service PIC Revenue Code <br /> ' I Amount <br /> Ca ies ~ cl~ci~C~ SUS e~_ Jr'S~ <br /> 53/- 32 - ~ D-4 - r Z <br /> ~L ~o',~o ~iJ 01a~-i r~ned <br /> Total Due <br /> <br />