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:v w v -* 'T— , i,. <br />(attach additional sheets if necessary) <br />^OIRCT information must be submitted by_the—appli^tign <br />deadline date in order for your applicaMoP_to be considered complete <br />2l~^Certified Property Owners List of owners within 150* (you must obtain <br />this list from Hennepin County Department of Finance A-603 Govt Center <br />^ 348—327X) • <br />.a,' 3-Plat Map (obtained with property owners list). <br />r ^.r <br />4. V' Certificate of survey (signed by a licensed surveyor) to include <br />hardcover calculations as required (provide one (1) copy 8% xll for <br />reproduction). ^ u <br />57 Topographic survey (existing and proposed elevations) if any changes <br />in existing grade are proposed (provide one copy Sh^xll ). <br />6, Slcetches or plans of floor & elevation views (provide 1 copy xll ). <br />7. <br />Siteucnes ui. pa.axio v^x- - -- - - - - - - -- - - - j. -i <br />As an addendum to this application, please attach a separate list of <br />any other persons you wish notified of this application. <br />8,_ _^Additional items as may be requested by City staff. <br />\-<T The Applicant and Property Owner must sign this application. Please <br />remember that your variance application is not __ccmplete—if—the-------ove <br />xnf on has not: been included. <br />> <br />APPLICANT'S SIGNATURE <br />^ The applicant hereby agrees to provide all information required or <br />requested by the Zoning Administrator, agrees to pay additional fees (sta <br />time not covered by original fee payment) and/or consultant expenses <br />incurred in review of this application, and certifies that the information <br />supplied is true and correct to the best of his/her knowledge. <br />y <br />Applicant's Signature Date Z ^ <br />OWNERS SIGNATURE , _ <br />The owner hereby ackowledges and agrees to this application and ® <br />authorizes reasonable entry onto the property by City staff, consultant , <br />agents. Commission members, and Council members for purposes of investiga­ <br />tion and verification of this request. <br />Owner • s Signature <br />.rr.rtr’"::s;.r <br />Office of this change prior to the meeting. <br />-7:;^ <br />'J .- A..' <br />*1 <br />-i <br />:4 <br />1 <br />i <br />A <br />i