City of Eugene <br /> Public Works Maintenance <br /> Public Works Parks and Open Space °.,'7 <br /> 1820 Roosevelt Boulevard ate: <br /> Eugene, OR 97402 Eugene <br /> Tele # (541) 682-4800 <br /> Fax # (541) 682-4882 <br /> RECEIPT <br /> Date — <br /> From • , <br /> Address <br /> City/State/Zip <br /> Quantity Description Amount <br /> :1,7)7'2 ✓ ' t • <br /> ALS. ,1iCc <br /> 4 / Ke. <br /> TOTAL <br /> r�' <br /> Payment: ❑ Cash ❑ Check# 1 ZV�' 0 Credit Card <br /> Received by 1+ <br /> SUMMIT BANK 1200 <br /> SB EAST BROADWAY <br /> FAM-LEE LLC EUGENE,OR 97401 96691,1232 <br /> PO BOX 839 <br /> PLEASANT HILL OR 97455 <br /> 5/18/2017 <br /> PAY TO THE <br /> ORDER OF City of Eugene $"461.32 <br /> Four Hundred Sixty-One and 32/100 ******** *** <br /> DOLLARS L <br /> Planning & Development • <br /> 99 West 10th Ave. <br /> Eugene, OR 97401 <br /> MEMO ','t. - �!i`� m. <br /> Street tree application Addyson Creek First Addition AUTHCRQ5D SIGNATURE <br /> • <br /> • <br /> 54-r2�--I-i <br /> ► 4 ( 3J V5 7? <br />