City of Eugene <br /> Planalag & Development Department <br /> Building & Permit Services <br /> 99 W, 10th Avenue <br /> Eugene, OR 97401 , <br /> Customer Information: Billing Information: <br /> Ci~y v~ ~ <br /> Customer Nam~JCompany pots <br /> Addreu Pwehase Order Number (non-C(ry departmentrJ <br /> ~G on- g-~~r~ <br /> Clry, State, Ztp Ciry Job Number o. Account Code <br /> ~ s2~g . <br /> Customer Tilepbons Department to be B(Ued <br /> <br /> G~N~~-- ~~c~s <br /> contact Name <br /> Q~~tY Description of Service PIC Revenue Code Amount <br /> Total Due <br /> y <br /> <br />