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City of Eugene ' <br /> Planning & Development Department <br /> <br /> _ Building & Permit Services <br /> 99 W. 10th Avenue <br /> Eugene, OR 97401 <br /> Customer Information: Billing Information: <br /> 8-lv~~y <br /> Customer NamdCompany Dolt <br /> Addrtss Purchase Order Number (non-Ctry departmenuJ <br /> City, State, Ztp CIry Job Number or.lccount Code <br /> . o~~ <br /> Customer Tdtphona Dtpartmtnt to bt Bilkd <br /> Contact Namt ~ . <br /> ~f1.~I l ~i ~Y lgo G,~ <br /> Quantity Description of Service PIC Revenue Code Amount <br /> i o . od <br /> ,go <br /> 0 ~ _ ~ _ Total Dtrt <br /> <br />