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City of Eugene <br /> Planning & Development Department , <br /> Building & Permit Services ' <br /> 99 W. 10th Avenue <br /> Eugene, OR 97401 <br /> Customer Information: Billing Information: <br /> es i~E- bl~~a~ <br /> <br /> Custwnsr Company Hats <br /> Pry ~~x ~.~7~ <br /> Purclwss Ordsr Nwnbsr (non-Ctry dspartmcnls) <br /> Ctry, S , Z1P Clry ob N r or.lccount Cods <br /> Customer Ts/ephons Dsparpnsnl to be Bl/kd <br /> Contact Nano <br /> Quantity Description of Service PIC Revenue Code Amount <br /> _ 1- <br /> Tota/ Due <br /> <br />