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E U G E N E <br />PeAs and <br />Open Space <br />Date August 14, 2006 <br />❑ City Plant, Option A. Developer pays City to assume responsibility <br />for requirements under E.C. 7.280 related to this development <br />Developers Name Walter Kiefer Holdings, LLC <br />p Developer Plant, Option B. Developer contracts with City to meet <br />Mailing Address 2863 Riverwalk Loop <br />requirements of E.C.7.280 related to this development <br />Eugene, OR 97408 <br />Phone: (Home) <br />Name of Representative Poage Engineering & Surveying, Inc. <br />(Work) 683 -6355 <br />Mailing Address P.O. Box 2527 (990 Obie Street) <br />Name of Corporation <br />Eugene, OR 97402 -0152 <br />Name of Partnership <br />Phone 541/485 -4505 <br />Name of Individual <br />Special Notes <br />Applicants signature <br />FITY USE ONLY <br />Date received <br />- <br />Fees paid: <br />❑ $300 Application Fee + 0.01 /ft <br />Account # 131- 9650 -45790 <br />❑ $100 City Plant, Option A <br />Account # 131 - 9650 -45790 <br />❑ $200 Developer Plant, Option B <br />Account # 131 - 9650 -45790 <br />Comments: <br />Authorizing Signature <br />Title Date Signed <br />Please note that this is an application form, not a permit. <br />Questions regarding completion of this application form or the application review process may be directed to: <br />City of Eugene, Office of Urban Forestry — Phone 882 -480 <br />January 2004 <br />1820 Roosevelt Blvd. Eugene, OR 97402 77 <br />Deleted: <sp > <sp> <br />