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���Y �f �rQ�o PC ExhlbitA <br /> �onditivnal l�se Per�ni# Applica�ic�n <br /> Sbeet Address: / r �/ <br /> ,�,o�.0 2750 KeNey Parkway ApA�fCati0T1# � <br /> Orono,MN 55356 Date Recsived: - —� <br /> ���-�' Main: 952 249-4600 Staff: �� <br /> fax: 952-249-4616 F�: �� <br /> •'� y' Malting Address: Escrow#& � <br /> 'S'�, � `�' P.O,Box ss S <br /> 1��k5}i OR�c. <br /> G crystal say.I�f1V s5823-0066 Pe►ml#�9e <br /> Notes: <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> lncomplete applications vsrill not be placed on Ptanning Commission Agendas. <br /> sR�►.ocA�ioN: ���� (.L(,�'I/l�L° � �I? L°., <br /> APPLICANT!AGENT INFORMATION; <br /> Applioant Name: � .q <br /> Phone(Primary}: b�Z - �,t • ��,.� ► <br /> Applicant Email: �� - <br /> Address: �v v ie.0 G,�� e �� Ci <br /> Agent Name� R1[�Ia � �'-' a��^� ZiP �S 3_4(T <br /> �J3D_��,�,,,I�.,�_ 9enYs phone number <br /> Agent Email: r Sfo r���(� �w�.r�0,np i t is: Coniractor � eowr � (C;rc�e One} <br /> pROPERIY QWNER INFQRMATION: �,he��i2f prnperty owner is same as applicant <br /> Natne: ""',�n � �Y <br /> Phone(Primary): <br /> Malling Address: City: ZIP- <br /> Email: � <br /> APPLICANT7AGENT AND/pR QWN�R; <br /> • Agree to provide alf intormation required or r�equested by the Planning Department, <br /> • Agree to pey eddtlonal fees{staff time nat covered � the original fee paymeM)arxllar cbnsuRarn expenses incurred in <br /> review of this application,and <br /> • Certify that the �formation suppiied is true and correct tp the best of his/her knowledge. Ths applicant end owrier <br /> recogNze that they are saiely responsibie for submitting a compteie applicatlon being aware that upon fallurs to <br /> do so,the staff hes na altsmaUre but to reject it until it is camplets or ta recommend the request for deniai qf the <br /> requeat regaroless of its potentlal merit <br /> • Acknowledge the Escrow Agreement is cornpleted and signed. <br /> • The Owner hereby ackr,owledg�s a�agreea to this application and fiMhef autt�oqzes reasonabfe entry ornp ttte prppe�y <br /> by City Staff,consultarrts,ager�ts,Commission and Council Members fur purposes of irrve��ystion and veri�cation of this <br /> fBQUP.St. <br /> • Owner and/at App�fcant ackno�wledge tf�ey mu�t be present at all scheduled review meeti�gs o#�e pianning <br /> CommiCCiOn atld Couneil. !f an eppliesnt and/or ownar ia unabie to attecid a scheduied meeting, please make <br /> arrangements to have an authorized representaUve ettend in place of the applicanilowner and advfse the CI�, p�nner <br /> assigned to your project. <br /> ApplicanUAgent Signature: Date: 3�� • � �4 <br /> Applicant/Agent Slgnature. Date: ��Z,2,��� ` <br /> Property Owner Signature: Date: <br /> Property Own�r Signature: <br /> ��v .� <br /> CUP Applfcation—January 2016 <br /> P�2 hiAR 2 � �Q1�a <br /> __ _ ___--_ �Cl1Y OF ORONO � � � � � ` <br />