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� PC Exhibit A <br /> City of �rono <br /> Variance Appiication <br /> Streer Address: qPp�icaUon� (� '� '� (� <br /> �Q�A rO 2750 Keqey Parkway <br /> �"'��� orono,AAN 55356 Date Recetved: —` �--,�2 YT <br /> Main: 852-249-4600 Staff � _ <br /> fax: 952-249-46 i B Fee . eo �o'r,l �+� /Z O l �' <br /> ,� Melling�4ddress: Escrow#8 a /� �` <br /> `� � P.O.Box BB <br /> � G~ Crystal Bay,MN 55323-0p66 Perm�t Fee <br /> r�k�SHo'�� Notes: <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomptete applications will nat be placed on Planning Commission Agendas. <br /> SITE LOCATION: ��.I.c, <br /> DESCRPTION OF REQUEST: i�ID�� OZ�,n ZZ Y`i a o d� <br /> (attached additi8nal sheets as necessary) <br /> APPLICANT/AGENT INFORMATION: <br /> Applicant Name: �pH U ��1-, - ����t,on �L[� '' <br /> Phone (Primary): qS�-- Sya�-?1 S� <br /> Applicant Email: JD�+y (`e�i s��,��l�_�v++n <br /> Address: 3 5+ �City' W�4z�.��- ZIP- S53Q j <br /> Applicant is: Contractor Homeowner (Clrcle One) - <br /> PROPERTY OWNER INFORMATION: �check here if property owner is same as applicant <br /> Name: O n N <br /> Phone(Primary): 6 z- $- � <br /> Mailing Address: �� dti w Ci ; Z�P: .S S <br /> Email: � S <br /> APPLICANTIAGENT AND/OR OWNEa; <br /> . Agree to provide sN IMormation requlred or requested by the Planning Departrnent, <br /> • Agree to pay additional fees (staf#time not covered in the original fee paymerrt) andtor consultarrt expenses incurred in <br /> review of this spplicatbn,and <br /> • Certify that the information supp6ed is true and comect to the best of hfs/her know[edge. The appllcpnt end owner <br /> rec:ognize that they aro solsly responstble for submftting a complets appllcatlon being aware that upcn fallunr to <br /> do so,the staff hes no alternative but to reject R unti!it Is complete or to recommend the r�queet Tor denlal oi tho <br /> request repardt�s of It�potential merFt. <br /> • Acknowledge the Escxow Agreement is compfeted and signed. <br /> • The Owner hereby acknowledges and agrees to this epplk�ation and further authorizes reasanable entry onto the property <br /> by City Staff,consuttants,agents,Cornmission and Councif Members for purposes of investigation and verifiq�on of this <br /> request. <br /> • Owner and/or AppllcaM acluiowledge they must be prosent et all achsduled revfew rr�eetlnq� of ths Planning <br /> Commisslon end Councll. If en applicant and/or owner is unable to attend a scheduled meeting, please mafce <br /> arrangements to have an authorize sentaBve attend in plaoe of the appl�CanVowner and advise the City Planner <br /> assigned to your projed, <br /> Applicant/Agent Signature: Date: S /7 �C <br /> ApplicanUf�qent Signature: Date: <br /> Property Owner Signature: Date: <br /> Property Owner Signature: Date: <br /> v8�,a�r�no„_a�i�is MAY 1 8 Z�f�i <br /> p�� � V �� C1�'Y 4F ORONO <br />