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City of lrugene <br /> Planning & Development Department <br /> Building & Permit Services <br /> 99 W. IOth Avenue <br /> Eugene, OR 97401 <br /> Customer Information: ~ U 7 5 <br /> Billing Information: <br /> Customer Name/Comparry Date <br /> g~~ <br /> <br /> A~~ Purchase Order Number (non-City departments) <br /> one D ~ ~ ~ ( <br /> d. b#Lf v~Z(- G13~5 ~ ASS/! ~ <br /> Clry, Stats, Ztp City Job r or Account Code <br /> $ ~ d l $ ~~Y,L~C L ~Or1GS I <br /> Customer Telephone ~Q <br /> De tment to bt lied <br /> <br /> Contact Name <br /> Q~~ty Description of Service PIC Revenue Code Amount <br /> ~ h~ ~t~- - PSI r~ <br /> - ~~e~ hh ~-t~. ~o - <br /> - - <br /> ~D. a0 /$l - c,'~~ l - X11,3 b"v~ Total Dut <br /> ,F.~~ <br /> <br />