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NRY-21-2003 15! 39 <br />• ir»* <br />.;■ • > <br />PLEKKENPOL BUILDERS INC 952 688 2259 P.^3^ <br />REQUnUED SUBMRT a U <br />All of fht foliowtog iwfon—tto0 iMiit b« MbMaitd hv Hkt annUeatf— d—iiHii» 4mtm In <br />for %onr ■yqlle»tloa to bt ca—Mirid epimlit: <br />1. <br />2. <br />3. <br />Completed AppUeetioa Pocb <br />Ccitified Piopcrty Owners List of owners wiihio 150\ Isbrls lod pUl map must <br />obtain this list, labels and map from Hennepin Ceunty Deputineni of Finance A*€03, <br />Govt Center, 348-S910). <br />CeitiAeate of Survey (signed by a lieensed surveyor) and include hardcover <br />mmo AMM <br />4. <br />calculations as required. ' In additioo, provide ono (I) copy 8)6* x 11" fbr <br />itproduciioo. <br />__ Topographic survey (emstinf and proposed elevatioas) if any changes in existing grade <br />are proposed, b addition, provide one (1) copy 8!6" x 1 1* for rtprodaciioa. <br />5. Sketches or plana of floor it etevadon views (^vide one (1) copy 8H" x 11"). <br />6. Lisl ^ i4fai names (inelude marital status) of all persoos with an intmest in the <br />pfopet^. This would inelude nanu(s) of sppUcani(s) if not current owner(s). <br />_ As an addaidum to fliis applkatioa, please attach a separate lift of any other persons <br />•>90 wish notified of this applicition. <br />8. _ Additional itemi at may be requested by Gty staff <br />The Applicant and Propeny Owner must sign this appUesUon. Please lemembet that yf«r <br />yirigflMJTOUmUfl IS wot CfflBPlctS if the ^ave infemailen he« not been leel^dwl. <br />APPUC>LM*S 6KCNATURE <br />The applicant hereby agrees to provide all iafKination required or requested by the Zonipg <br />Administiaior, a^es lo pay additional fees (staff time net covered by original fee payment) and/or <br />consultant expenses incurred in review of tlus application, and certifies that the information <br />supplied is tiue and correct to the best of his/her knowledge. <br />Applicant’s Sipiaiotc Date <br />OWNER'S SIGNA'.___ <br />The owner hereby acknowledgei and agrees to this appUcarion and fiinber auihoriata reasonable <br />Owner's Signs <br />tuiposes or uw^pga <br />Date <br />total P.Bl <br />(Jb D2CPl TOTAL P.03 1