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r <br />REQUIRED SUBMITTAI^ <br />All flf Ibt fftllQwfng inforynjiCion must be submitted hv the annitcatlod deadline dati> In <br />for vo ur application to be considered complete; <br />!• __ Completed Application Form <br />2. — Certified Property Owners List of owners within ISO*, labels and plat map (^u must <br />Go^^C^t *'*348^59^1^** Hennepin County Department of Finance, A-603, <br />---- Certificate of Survey (signed by a licensed surveyor) and include hardcover <br />calculations as required. In addition, provide one (I) copy 8*/i" x 11" for <br />reproduction. <br />4. — Topographic survey (existing and proposed elevations) if any changes in e.visiing grade <br />arc proposed. In addition, provide one (I) copy 8'/," x 11" for reproduction. <br />— Sketches or plans of fioor & elevation views (provide one (1) copy R'/j" x 11"). <br />6. — List of the legal names (include marital status) of all persons with an interest in the <br />property. This would include namc(s) of applicant(s) if not current owncr(s). <br />7. — As an addendum to this application, please attach a separate list of any other persons <br />>-ou wish notified of this application. <br />__ Additional items as may be requested by City staff. <br />The Applicant and Property Ott’ner roust sign this application. Please temcrohci that your <br />varJapyy BPplic.ltioiLjlJLOiJ^pmpl^^ above information hnc ............. “ <br />APPLICANT’S SIGNATURi: <br />T^e applicant heteby agrees to provide all infottnalion required or requested by Uie Zoning <br />Administrator, agrees to pay additional fees (stafTtime not covered by original fee payroent) and/or <br />eonsuliant expenses incuncd in review of this application, and eertifies that the information <br />supplied IS true and correct to tlic best of his/her knowledge. <br />Applicant's Signature <br />OWNER’S SIGNATURE <br />Date <br />The owner hereby acknowledges and agrees to this application and further authoriaes reasonable <br />entiy onto the property by City staff, consulianis. agents. Commission members, and Council <br />members for purposes of investigation and verification of this request. <br />Owner’s Signature _Date <br />i£=.=|S“£r3ES--S <br />M. <br />afi-U: <br />. <br />rt »\ r--. <br />s S Atft/ 'w'