BLISS UNLIMITED,LLC 19787 <br /> City of Eugene Parks and Open Space 12/12/17 <br /> Date Type Reference Original Amt. Balance Due Discount Payment <br /> 12/6/17 Bill 171206 253.00 253.00 253.00 <br /> Check Amount 253.00 <br /> t 1(7— Sell - 9r]a 1+11 <br /> 1 <br /> ‘.? r1/4--1 l t <br /> Citizens 253.00 <br /> • <br /> City of Eugene–Public Works <br /> Parks and Open Space <br /> 1820 Roosevelt Blvd. <br /> Eugene,OR 97402 <br /> Ph: (541)682-4800 Eugene <br /> sax: (541)682.4882 <br /> RECEIPT The <br /> Date: 1 C I ! 310 N <br /> 1 - / . X) C��tA� � <br /> Name: i� I ' 1 r- L.Q.L. ( r,i.; l:c l lv <br /> I <br /> Quantity Description Fee: Circle One <br /> Standard Use Permit Application Fee (Non-Refundable) $15 / $30 <br /> Special Use Permit Application Fee (Non-Refundable) $40 / $80 <br /> Facility Fee or General Use Fee $ <br /> Security Deposit Fee (Refundable) $150 <br /> Vehicle Access Permit Fee $10 / $25 <br /> Other Fees 7 $ <br /> `IS 9Sr0 - 310 <br /> i3/- 7‘,50 -47 -7-1 TOTAL $ 5o8. 3i <br /> Payment: : Cash Check# — Credit Card ( ear St c9 <br /> 1 <br /> Received by: <br /> i l70)ti <br />