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of O <br /> ti~ <br /> H t _ ; o Y~~®n ~ ~ r ~ State Landscape Architect Board <br /> ' ' z j j ®~a'rE' 1193 Royvonne SE, #19 <br /> Theodore R. Kulongoski, Governor i N ITIALS: Salem, OR 97302 <br /> 18 59 <br /> (503)589-0093 <br /> Fax: (503)485-2947 <br /> Renewal Notice for Registration as Landscape Archit~~~~~~e~''~on.goV/landar~h <br /> License # LA507 July 15, 2008 <br /> License Expiration Date: August 31, 2008 ~ ~ <br /> Current Mailing Address in OSLAB system: ~ l.~ v <br /> ~~g~~ <br /> SCOTT R. MILOVICH <br /> CITY OF EUGENE, PUB. WORKS ENG. <br /> 858 PEARL ST <br /> EUGENE, OR 97401- <br /> <br /> . • Please be advised that your OREGON State Landscape Architect registration will expire on August 31, 2008. To renew your <br /> registration through August 31, 2009, please return a copy of this form with any address changes noted below and the renewal fee of <br /> $250 for Landscape Arciiteet; $25.00 for Emeritus Landscape Architect;. $SO,00 for Landscape Architect in Training. Your <br /> registration becomes delinquent if not paid by August 31, 2008. <br /> • Renewals may be paid within 30 days after the renewal date "without a late fee". <br /> • Renewals paid later than 30 days but not later than 60 days after the renewal date must include a $100.00 late fee. Any Landscape <br /> Architect failing to pay the renewal fee and, if applicable, the late fee for a period of 60 days after the renewal date must appear before <br /> the Board for purposes of reinstating the registration and must pay any required examination fees, renewal fees, and late fees. <br /> • Check should be made payable to OSLAB and then include this signed completed form in the enclosed green envelope. <br /> Please confirm the. following information. <br /> If the. mailing address above has changed, please designate which address below should-be used for your mailing. address. Draw a line <br /> through any incorrect information and print correct information: `If no information is present; please add any missing information, <br /> Your address information in our database is: <br /> Address Type Home Use for Mail? <br /> Address 1 1857 Praslin <br /> Address 2 <br /> City Eugene State OR Zip 97402- <br /> Phone (541) 607-5766 Fax <br /> Email <br /> Address Type Work Use for Mail? <br /> Address I City of Eugene, Pub. Works Eng. <br /> Address 2 858 Pearl St <br /> City Eugene State OR Zip 97401- <br /> Phone (541) 682-6086 Fax (541) 682-5032 <br /> Email scoff.r.milovich(c~ci.eugene.or.us <br /> a~ v, <br /> PROFESSIONAL DEVELOPMENT HOUR (PDII:) CERTIFICATION <br /> B.y my.signature below; I certlfy'to the Board thaYerther:'(a) I have completed the required'professional development;hours;(PDH) for renewing my <br /> `landscape architect registration and am able to provide; upon request; both'a PDIT log and b"ackup documentation: to prove completion of he activity <br /> shown on the log, as required by OAR Chapter 804 Division 25; or (b) I am exempt from the continuing education requirements under OAR 804-025 <br /> -0010(1) and am able to provide documentation to prove my exemption. I also understand by signing below that completion of the continuing <br /> education required by the Board under OAR Chapter 804 Division 25 is a condition for renewal of my landscape architect registration unless I am <br /> exem t from those re uirements. <br /> Signature• - Date: ~ <br /> Scott R. Milovich License # LA507 JUL: 1 ~ ZOOE <br /> <br />