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Cif o1..dgene - <br /> PlanninY & Development Department - _ i <br /> <br /> wilding & Permit Services ~ ~ ~ <br /> ~ rsa cf ac- <br /> 99 W. 10th Avemte I o ~ ~ z ~ ~ ;t <br /> Eugene, OR 97401 ~ m 3 0 ° ' ~ <br /> ?3 ~i <br /> Castomer Information: Billing Information: ~ m <br /> Customer NamdComparry O°~ ' ~ <br /> ~c ~ ~ <br /> 2 ~ ~ 131~c-O~Jw~` ~ ~ ~ <br /> Addrtss Purehast Order Number (non-City depar i) <br /> ~ , <br /> City Job Number or Account Code <br /> Ciry, Stare, Zip <br /> Customsr Tekphwtt Department to be Billed <br /> Contact Nams <br /> Quantity Description of Service PIC Revenue Code Amount <br /> / Er~os?o~~ )2~G P~M-t- D~Q S0- <br /> ~v Ca~P,~i~luT~ .~~U/.D~a <04.00 <br /> 11 . d <br /> - - o ue <br /> - - <br /> <br />