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- ~ 3~~ag <br /> City of Eo,;~uue t 2 • t $ • o Z' <br /> Planning & Development Department <br /> Building & Permit Services - <br /> 99 W. 10th Avenue <br /> Eugene, OR 97401 <br /> Customer Information: Billing Information: <br /> C~~~ of ~U(,~~ a~~ ~M~N 12 <br /> Customer Nanu/Compaay t)ate <br /> <br /> Addcss Purchase Order Number !~-City dsparanenul <br /> ~u~~~ , Cam- 9~y61 X1603 s3 r - X33 at ,-v K C~ <br /> Ctry, State, Zip City Job Number or Account Cods <br /> customer rslephons Department to be attted <br /> ~~:ful?~..~ F(N~~~-f ~~(,~-r,~.(~o,,~ts ~n htw~~e v~'~.~.-, t <br /> Contact Nano <br /> Quantity Description of Service PIC Revenue Code Amount <br /> .Z 1.1 MI'rF~ ~ C6Y~iSl.~7gT/6~1 tis~- ~rzt~- ~sss y~21 ~ l~p•od <br /> ~M 11~-s ~5 - ~-fZ~o - ~tssgo L~ X75 ~Q , 5d <br /> l~n~~.~ <br /> ~Giui Dii~ <br /> <br />