Laserfiche WebLink
' PC Exhibit A <br /> �f�► �f �r�1'�{� <br /> �or�d�t����� �1�� ��r�ni� ���l��a�i�� <br /> ���� s�f�: <br /> z75a Ic.�ky parkh,ay Appti�etfon# � 2� <br /> orano,NW b5356 Date Reoe�ved: �� <br /> r - �L AAairc 952-249-1800 ��' �li <br /> fa�c 9b2-249-4B9H F@e: <br /> � 5` MmN'mQ�Addreas: �sCrow��$ <br /> 'S' � P.O.Rox 86 <br /> �t� ��~ �n�eer,auv s�ax�-0oaa pem,tt Fee �?0 <br /> �L�S H 04 Notes: —~`...�-- <br /> Piease compfete. Appiicant wi11 be notified the status of the applicat�on. <br /> lncomplete�pplications wlfi placed on PlanninA isslon Agendaa. <br /> SITE LOCATlON: � f�r l B°�� j o�t�.���. � <br /> APPLICANT!AOENT tNFOttAliA�ION: <br /> Apptiqnt Name: � ` <br /> Phone(prirnary): - <br /> Applicant Email: <br /> �'�: c� : za zr�: 5 5 3q � <br /> gent Name: Agent's phone number <br /> agent�mat�: @ w a sca cs.r,�w+��c��t ts: antracto Haneorvner (Circle Oasj <br /> PROPERTY OWNERC FORMA7i�0a: ❑check�J,p r P.roPert1' er is same as applk;ant <br /> Name: -� <br /> Pi�one(Prirr�ary�: <br /> Mailing Addr�ess: <br /> Email: G � m ZlP: p <br /> APPLlCANTlAOENT AHDlOR ON[NER: .� <br /> • Agree to provide a!I l�omlatbp r�squired ar request�l by the Plennk'rp Dep�rtmsrrt� <br /> • Agrae to Fay add�ianel�ea6 (s�fl�rrie not c�vered In the originet fee PaymeM}and/nr c�nsultartt expenses incxirred in <br /> revlew of this apPlicatbn,and <br /> • Certtfy ihat the irrfortnetion ssippl(ad is true 8r�d corred io the bebt of htslher knovvled9e- The appltcant and oNmsr <br /> naeognize that they are solely responalbfe for subrnitting a aon+ple�e applicatlon beMg aware that upon faiiure tn <br /> do so,ttt�afaff tras no a!lemsttve but to trject it�til J�is complete ar ta recommend the requ�t for denta!aF fhe <br /> r�q�uest rogardksa ot tes poterti8al ms�ik, <br /> • Ac'.fmowlec�ge the Eecxow Agreemerrt is cornple�ad ertd sigtted. <br /> ' '�tY��O�e�r�her�DY�adnnaurledgee and agreeB to tttls appl�cation and furthee authorizes re7soneble entry orrto the ptflperty <br /> Y KY � ,agenis.Commission and Counc�Members for purpose�of Investlgetion and rre�lforl af thia <br /> �� <br /> • Commisslbn �Caunncil. I���e�mugt be preaent at ali scheduled revfew rt�etfng� of tfie Planning <br /> appltcant and/ar owner ls unab{e 6o attend a scheduled meeUng� pbeae make <br /> srrarr$emerrts to have an authorized ropresentetive ettend in piace of the applicar�lownet and advfse the City Pianner <br /> asslgned to your proJecx- <br /> Applfc�ntlAgent Signature: �c.k. Date: Z.�1. � � <br /> Applicarrt/Agetrt Signatur�e: p��; <br /> Property Owner Signa#ure � Date: <br /> Praperty Owtter 5igrtattane� Date: <br /> cuP a�o„-J„wary 2ois <br /> �°2 RECEIVED <br /> APR 0 6 2A1R � � � �� <br /> ('.ITY nF nRnnin <br />