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City L, Eugene <br /> Planaing & Development Department <br /> Banding & Permit Services <br /> 99 W. loth Avemie <br /> Eugene, OR 97401 <br /> Customer Information: <br /> • Billing Information: <br /> ustamer Name/Co ~ ~ ~ <br /> ~1 Dote <br /> .lddreu L 1 ~ / <br /> Purchase Order Number (non-City departments) <br /> d <br /> City State Zip ~ ~ ~C..~~ <br /> G+ry Job Numbe/r/or~.fccount Code <br /> Customer Teleph _ ~//V <br /> /~/Y ~Z" " „ ~J~ , Department to be Btlled <br /> Contact Name C. „IJ~G/ ..,~.-----"',__~j <br /> Q~bri Description of Service <br /> PIC Revenue Code Amount <br /> 2?~~' <br /> Gd~~d7"? ~C --G 535 - 1 _ 54~ ~a ~ (1`~ <br /> <br /> 2 ~'DC J <br /> ~ ~~~q~ ~D~~C~I~ <br /> 7 <br /> ~ ~ _ _ <br /> ~G ~ Apnn ~ t.,1 F ? 5 4 ~.1 i - 5~a Cv~U , cX3 <br /> , (ca <br /> ~~~~1~ <br /> Total Due <br /> <br />