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City of Eugene ~ <br /> PlanninY & Development Department ~a~,~;,~ QS - - <br /> BuIIding & Permit Services ' <br /> 99 W. 10th Avenue In,t 5 : S r-~ -4-v <br /> Eugene, OR 97401 <br /> Customer Information: Billing Information: f ~ ' <br /> <br /> Customer Namt/Co ~/~(J Date <br /> <br /> A~,u Purchase Order Number (non-City departments) <br /> ~y~~-~ ~r~ 1 <br /> Ctry, Swte, Zip CtryJob Numb`er~or)decount Cods <br /> ~vV <br /> Customer Te/eph _ Department to be Bllled <br /> Contact Name <br /> Quantity Description of Service PIC Revenue Code Amount <br /> ~ ~ Sia~? l ~'6-G s~~ -q3a~-~-~.~s~- .~0 ~ c~ <br /> ~ ~ Ise - 4a II - 45 -z~, <br /> / / r ~ / <br /> ~jl(/ S p~p~n tom( ~E~ ~ 51 - 4a-1 I - y S~~-(o ~ . ~ <br /> Total Due <br /> <br />