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City of Eugeae <br /> Planni~ & Development Department <br /> BuUdIng & Permit Services <br /> 99 W. 10th Avenue <br /> <br /> Eugene, OR 97401 <br /> <br /> Customer Information: Billing Information: <br /> Customer Name/Compairy Dote <br /> dddress Purchast Ord22sr Numbtr (non-City departmsnu) <br /> ~l <br /> Ciry, Stats, Zip C(ry Job Numbcr oc Account Cods <br /> ~~,r t ,2YI of <br /> Customer Telephone Department to be BllJed <br /> Contact Name <br /> Quantity Description of Service PIC Revenue Code Amount <br /> / D v <br /> u~ <br /> ~ <br /> v <br /> G3-12-J4 AO:~ ~ 17 RCVG Total Due <br /> <br />