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<br /> R <br /> CS~y of Eugene I E2outs Date ~ $ I <br /> Planning & Development Department I ~~o; ~~r. ~c..Qd/y ~ i~y <br /> 'Building & Permit Services Job No. Z Set <br /> Contr No. 1 <br /> J~ 1 ~ ~ <br /> 99 W. 10th Avemte <br /> Eugene, Olt 9740I Assessment? YES or <br /> i ap ove tpis for <br /> Customer Information: Signa a Date Billing Information: <br /> Customar N Company Dais <br /> Gil` 2- <br /> Address Purchase Order Numbsr rtmsnu) ~ /~j~ } <br /> ~i c~~ C~ • ~W l L~%Lf!/Gt/ <br /> Ctry, Seats, Zip b Number or <br /> f ~..-~2~ `1 <br /> Customer Tskphopne/Q ~ ~ Department to bt Billed <br /> ~e~ <br /> Contact Nams <br /> Quantity Description of Service PIC Revenue Code Amount <br /> ~ slaw ~aa~o c ° _ 5 -5 S ~ Z~ 50 <br /> l l~~'~ ~~~o o• - 4~zz i . ao <br /> l ~~/12~it1 -~saa~ -psi ~~z~ ~ • ~d <br /> ~ <br /> - <br /> Total_Due <br /> <br />