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PC Exhibit A <br /> City of Orono <br /> Variance App[ication <br /> Stresi Address: qpplication# � �� <br /> ���o�0 2750 Kelley Pa�icway I <br /> Orono,MN 55356 Date ReCeived: <br /> Main: 952-249-�1600 Steff: ��, � <br /> I <br /> fa�c 952-249-4816 Fee: <br /> ,� � �„ MaiNng Addre,ss,- ,,., '� <br /> � a ti P.O.Box 66 EsCrow#&g `,L �,_J <br /> ♦ �"'d <br /> � G Crystal B2y,MN 55323-0p66 Pemlit F&e <br /> j�'��'SH04'ti Notes: <br /> Please complete. Applicant will be natified within 15 days as to the status of Ute application, <br /> Incornplete appllcations wilf nat be placed on Planning Commission Agendas. <br /> SITE LGCATION: I O?,,� S�.� � �.� i� ��( ���3� , f��� <br /> .��.��.a.."� <br /> bESCRPTION OF REQUEST: � <br /> (at ched additional sheets as neces ) " <br /> APPLICANT 1 AGENT NF ATION: <br /> Applicant Name: <br /> Phone(Primary): <br /> Applicant EmaiE: CD <br /> Address: 5 r' City: �►^Oh.O ZIP: 53 <br /> Applicant is: Contractor o eo {Circle One) <br /> PROPERTY OWNER INFORMATI�N: check here if property owner is same as appiicant <br /> Name: _��n.�. `�,o�, � �,, <br /> Phone{Primary): 2, t� ' ����" ' <br /> Mailing Address: p �,�, , w � Ci{ ; Z�p; � ��� <br /> Email: <br /> APPLICAN7IAGEN7 AND/OR OWNER: <br /> . Agree to provide al!Info►mation required or requested by the Planning Department, <br /> • Agree to pay additional fees (staff time not covered in the original fee payment)and/or consultant expenses incurred In <br /> review of this appUcation,and <br /> • Certtfy that the fnformation supplied is true and correct to the best of his/her knowfedge. The appllcant and owner <br /> recognize that they are solely responsible for submitting a complete appllcation heing awar+e that uport failure to <br /> do so,the ataff has no altsmative but to reject it until tt ls complete or to recommend the request for denial of tt�e <br /> rea�uest regardless of Its potentlal merit. <br /> • Acknowledge the Escrow Agreement is completed and signed. <br /> • The Owner hereby acknowledgea and agrees to this application and futther authorfzes reasonable entry onto fhe property <br /> by City Staff, consultants,agents, Commission and Coundl Members for purposes of investigation and verHication of this <br /> request. <br /> • Oarner anef/or Applicant acknowledge they must be present at al1 scheduled review meetings of the Planning <br /> Commission end Councll. If an applicant and/or owner is unabie to attend a scheduled meeting, please make <br /> arcangements to have an authorized representative attend in place of the appllcanUowner and advise the City Planner <br /> assigned ta your projeCt. <br /> ! <br /> ApplicanUAgent Signature: Date: � �� `� <br /> Applicant/Agent Signature: Date: <br /> Property Owner 5ignature: Date: <br /> Property Owner Signature: R��VE� <br /> Varfance Appllcatlon—Apri12016 MAY 13 2016 <br /> Page 2 <br /> Ci'iY Uf ORONO � � Q �T,� <br /> V .✓ <br />