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06/13/2002 14;19 FAX 052 844 3350 <br />J«n-0l-200{ OhIQps Frei-CIT^'OF ORONO <br />SPECIALTY RISK SERVICES <br />MS224g4l1B <br />121004 <br />T-401 P.OOI/OOS F-223 <br />1. <br />2. <br />REQUn^D SirSMTITALS <br />An of the follo^ylng Jnfonuatton tnuot be mbmlfted hv the annIipgHnn iTawi IHwa dafe <br />order for vonr ■npMcatio»i_to be coiutdared gQmpli>ti». <br />Cocipleted Applicadon Fonn <br />Certified Property Owners List of owners within 150', labels and plat map (you <br />nu-'it obtain this list, labels and map flrom Hennepin County Department of <br />Fitumce, A-603, Oovt Center, 348>S910). <br />Certificate of Survey (signed by a licensed surveyor) and include hardcover <br />calcnlafioDS as required. In addition, provide one (1) copy 8V4" x II* for <br />lejaoduction. <br />Tofographic survey (existing and proposed elevations) If any changes in <br />gnide ana ptoposed. In addidon, provide one (1) copy 8 ’/i" x 11" for reproduction. <br />Skitdies or plans of floor St elevation views ^ito'dde one (1) copy 8^4" x 11"). <br />Llr; of the legal names (include marital status) of all persons with an inteiest in <br />tiui propeiQ'. This would metude name(s) of applicant(s) if not cunent ownei^). <br />Ai an addendum to this application, pleasa attach a separate list of any other <br />persons you wish notified of this application- <br />Aclditional hems as may be requested by City staff. <br />The AppUcani and Property Owner must sign this appUcaiion. Please remember that your <br />IMrianCft annilcaiion Is not complete tf the above itifnmiaHon h«< ni|t bean Incindfd. <br />APPLICANT'S SIGNATURE <br />The applicant tiereby agrees to provide all infonnation required or requested by the <br />Administrator, ugrees to pay additional fees (staff time not covered by original fee payment) <br />^or wniultant expenses incurred in review of this appUcation, and certifies^ the <br />information supplied is true and correct to the best of his/her knowledge. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />Applicanfs Siipiature Date C pT— <br />OWNER'S sk;natur £ <br />The owner her:by acknowledges and agrees to this appUcation and further authorizes reasonable <br />enny onto the property by City stfff, consultants, agents, Conuaission members, and ConneU <br />members for jurposes of Investigation and verification of this request. <br />Wl__Owner’s Signatire Date <br />AppUcant must have all submitlals into the City offices 25 days before the Planning <br />Commission Meeting. Planning Commission Meetings arc held on the third Monday of each <br />month. Appllcauto most be present at an scheduled i^«v meetings of the PUnnlos <br />Commission and CounelL If an applicant is unable to attend a scheduled meeting, please <br />make anangemsms to have an authorized agent attend in your place and to advise the BuSding <br />Sc Zoning Ofii:e of this change prior to tiie mggring 7