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(attach additional sheets if necessary) <br />REQUIRED SUBMITTALS , . <br />All of the folloving information must be submitted by the application <br />deadline date in order for your application to be considered complete; <br />1, Completed Application Form <br />2^ Certified Property Owne.rs List of owners within 150' (you must obtain <br />this list from Hennepin County Department of Finance A-603 Govt Center <br />348-3271). <br />3^ Plat Map (obtained with property owners list). <br />4^ Certificate of survey (signed by a licensed surveyor) to include <br />' hardcover calculations as required (prov: • one (1) co-' ' P'5"xll" for <br />reoroducticn). ^ <br />5. Topographic survey (existing and proposed elevations) if any changes <br />in existing grade are proposed (provide one copy 8%'’xll"). <br />6. Sketches or plans of floor s elevation views (provide 1 copy 8%”xir*). <br />7. As an addendum to this application/ please attach a separate list of <br />fixiy otn03T p02Tsons you wish notxfx0d of ^hxs sppXic3.txon» <br />8. Additional items as may be requested by City staff. <br />The Applicant and Property Owner must sign this application. Please <br />remember that your variance application is not complete ——the—above <br />information has not been included* <br />APPLICANT'S SIGNATURE <br />The applicant hereby agrees to provide all inforI»^tion required or <br />requested by the Zoning Administrator/ agrees to pay additional fees (staff <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 cornet to the best^of his/her knowledge. <br />DateApplicant's Signature <br />ONHERS SIGNATURE , . , . a.4The owner hereby ackowledgas and agrees to this application and further <br />authorizes reasonable entry onto the property by i.ity staff/ consultants/ <br />agents/ Commission members/ and Council members tot purposes of investiga­ <br />tion and verificatiorv-gf this req^st <br />Owner's Signature Date / ? <br />Office of this change prior to the meeting. <br />. * <br />^ -t- -