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06/13/20Q2 14:19 FAX 952 844 3359 <br />Jun•D8•2002 01:tOpm FrowaCITY OF ORl <br />SPECIALTY RISI{ SERVICES <br />+9&22494816 <br />141004 <br />T•403 P.003/005 F-223 <br />REQUJRED S1CIBMITTALS <br />Al1 of the foll<t1!Dlll jnfonnation must he submitted by the anpJieatjon deadline date fn <br />order for-your_ applkatjpnJo_be consjder~d complete; <br />l. Com1pleted Application Form <br />2. Certified. Property Owners List of owners within 150', labels and plat map (you <br />mtJlt obtain this list, labels and map from Hennepin County Department of <br />Firnmce" A~603" Govt Center, 348 .. S910), <br />3. Certificate of Sutvey (signed by a licensed surveyor) and include hardcover <br />4. <br />5. <br />6. <br />7. <br />8. <br />- <br />-- <br />- <br />- <br />ca]c:ulations as required. In addition, provide one {1) copy 8½" x 11° for <br />re111'0duction. <br />Tl'.lGt0gmphic survey (existing and proposed elevations) if any changes in existing <br />gr2tde are proposed. In additio11t provide one (l) copy 8½1' x 11" for reproduction. <br />Sketclles or plans of floor&. elevation views (provide one (1} copy 8Ya11 x Uh). <br />Li:ri: of the legal names (include marital status) of all persons with an interest in <br />th41 property. This would include name(s) of applicant(s) if not current owner(s). <br />k an addendum to this application, please attach a separate list of any other <br />pe r,;ons you wish notified of this application. <br />Additional items as may be requested by City staff. <br />The Applicant 1and Property Owner must sign this application. Please remember that -y:mu: <br />wringpe an,nll~:ation is not complete if the above informatlnn ha~ not been includ.sd:, <br />APPLICANT' Si SIGNATURE . <br />The a.ppli~ant bereby agrees to provide all information required or requested by the Zo:aw.g <br />Administrator, ugrees to pay additional fees (staff time not covered by original fee payment) <br />and/or consult ant expenses incurred in review of this applicatiotii and ceni:fies that the <br />information su}plied is true and correct to the best of his/her knowledge. <br />Applicant's Sifi~lature ~a~ Date k\\p\D1-- <br />' <br />OWNER'S SIG-NATURE . <br />The owner heil:;'by acknowledges and agrees to this application and further authorizes reasonable <br />entty onto the J>roperty by City st;a:ff, consultants, agents, Conunission members 1 and Council ·- <br />members for t urposes o investigation and verification of this request, <br />Owner's Signab.tte ~~~~~~~\~U5Ll,--!l..!:::&:::::=:.. ___ Date ~---'\:,:.;_\-\-,\..;;;.?l...:.a.....,;;.'2-__ _ <br />Applicant must have all subr.nittal.s into the City offices 25 days before the Planning <br />Commission 1 [i:eting. Planning Commission Meetings are held on the third Monday of each <br />month. Appl ficauts must be present at all scheduled review meetings of the Pla1111iDg. <br />Commission a.a.cl Council. If an applicant. is unable to attend a scheduled meeting, please <br />make arrangen11ents to have an authorized agent attend in your place and to advise the Building <br />& Zoning Oftl,::e of this change prior to the meeting. <br /># 7