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1. <br />2. <br />REQUIRED SUBMITTALS <br />M .flf Iht follgyyiDg inforni alii)n be submitted bv the aDDllcallon deadlln.. Hm. <br />order for vour anplicaUon to be conddpr**^ —* <br />Completed Application Form <br />_ Certified Property Ouners l ist of o\s-ncrs uithin 150\ labels and plat map (you <br />must obtain this list, labels and map from Hennepin County Department of <br />Finance, A-603, Go\i Center, 348-5910). <br />Certificate of Surrey (signed by a licensed sur>e>x>r) and include hardcover <br />calculations as required In addition, provide one (1) copy SJ^j" x 11" for <br />reproduction. <br />— Topographic suncy (existing and proposed elevations) if any changes in existing <br />grade are projtosed In addition provide one (I) copy 8'/.- x II" for reproduction. <br />—. 5|'*‘‘chcs or plans of floor & elevation \iews (provide one (1) copy Sir x 11"). <br />List of the legal names (include marital status) of all persons with an interest in <br />the property. This would include name(s) of applicant(s) if not current owner(s). <br />As an addendum to this application, please attach a separate list of anv other <br />persons >-ou wish notified of this application. <br />__ Additional items as may be requested by City staff. <br />The Applicant and Property Otvner must sign this application. Please rememb-r that vour <br />)ar|.ir,ce appHcmlon is not comp jgle ir the above information l... not he,- lnrl.,n.J “ <br />APPLICA-Vrs SIC.NATLRE <br />T:.t applicant hereby agrees to provide all information required or requested by the Zoriina <br />Administrator agrees to pay additional fees (staff time not covered bv o.nainal fee rajmeat) <br />andcr consulia.-it expenses incurred in review of this application, and'ccrtincs that the <br />information supplied is true and correct to the best of hisTicr knowledge. <br />5. <br />6. <br />7. <br />8. <br />Applicant’s Signature Date <br />OWNER S SIC.NATL’RE _ <br />The owner hereby acknowledges and agrees to this application and further authorizes reasonable <br />entry onto the properly by City staft. consultants, agents. Commission members, and Council <br />members for purposes of investigation and vorifuMtion of this request. <br />O '.ncr's Signature <br />into-^hc <br />Date <br /># <br />? <br />f\J <br />':)