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<br /> =REQUIRED:SUBMITTALS: ': , � - . .
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<br /> . :All �of the�following":infocmafion must be submittetl:by the .application :tleadline date in'�order-for;your
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<br /> '� . �.17 ,`�, ,'�;�YR�❑ �.:, v,; �Practical Diffi:culties=.Documentation . ,A 4.,•� •\�,`
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<br /> '-`�, '�' ' �` L❑ - _:5urve ,cne�etin .ALL'r.e uir.ements:showntion° a'"e's 5�-e6 „� '�
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<br /> APPLIC�►NTr�►ND/OR OWNER - ., ;: '" °;. � � . , . `� � � ,,, � ,
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<br /> � r °X• ��Agree to`�pro�ideall mforrnation�requiredor requested by�the PJannmg Department, , ;
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<br /> };' ��• `Agree to;pay aiitlitiona9�fees;(staff:tirne nnt�cover,.e'd in�the original fee 4payrnent)°and7or consultant-expenses r '
<br /> ���' < � :inaurretl"in review of>fhis application;�antl°,` q:,= ' �� ,. � ;� �'
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<br /> � < �• ..�.,�er#if.}r that the informat�on_supplietl;is true,and�correct:to the best nf�his/herknowledge The�pphcant:;antl
<br /> , :�>' , ,~ ':niruner���r�eco,gnize that4they:are�so:lely responsible�o'r.subrriitEing�� complete<:appl�cafion�being::aware
<br /> :- ;-a � `;that;upon�Failure,,to ado .so, the::staff ahas -no:a�ternati�e-�but to ure,�ect�.it4�unfil it is �omplete or to� ;_
<br /> ` - �:rre.commend:the�request=for:denral-of the�equest�regartlless�ofF�ts�potenfialrmerit ` �
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<br /> ' ; s � t;• Acknowletlge`the1Escrow�Agreement4s<completetl and sigrl,etl ,;wr ;� � � t ,.;� � {�
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<br /> ;`, , �;• The Owner hereby�acknowletlges antl agrees-to�ttiis apPfication.antl�further authocizss reasonable ent,ry onto, ~�
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<br /> . -.. the ApeqperGy :b.y City;K=StafiF, �.consultants,;�agents, Coraimission and =Cnuncil �Members,�for :purposes �of �
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<br /> �n�,estigation and verification of'this request. z - �` '
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<br /> '� , , �•,�"Applicant rarid/or Owner°acknowledge;they mustMbe,preserit�at.zall scheziu7eil�ce��ew�meefin�s of�the
<br /> �>�� �� . �Plarining Comrriission<anci�Co.uncil •wlf�n�applicant�and/�r°owner is.unable'to aftentl a�:scheduled meeting, .
<br /> �` ; �please_rriake�rr•angements::to have::an;aufhorizetl representati�e�at�entl ►n�place of�thet�applicantlowner�and
<br /> ' 4 :�aduise`.fhe•Citai'.Planner assigned toryyour p�o�ect ;; ti�
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<br /> �x• 5orne��or:all:of�the rinfiorn�afion that you are.asked.to pr°o�ide:on thisrapplication is.:classified by.State.law as : ,';
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<br /> �� � -:either;:Private�o%:confidential�"•;Pri�ate.,data�is:infocmation=which�,generally.cannot be:;gi�en:to�the;�pu6fic:but;can� : �. ..
<br /> - �.:be,given°.to:the�subject�of�the tlata.��:Confiitlential-�data:isanforrnation�wiiich�generally,cannot,be.:;gi�en.to>:either �
<br /> '�,� � the�public or:fhe=subject of.;the.ciata, �Qur,-purpose antl::iritentled use:of`thisinforination.is:�to.annually update -
<br /> '' �` ' � ' '' �our:�recortls�.and:records�Lof�:other overnmerital�a encies re uired:b la�rv: If ,.ou .refuse`to`:�su I the
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<br /> �� ' ::iriforrnation;`.the-:a "lication'�ma �not:be`:issued. ^ :" ` ` � ' ` '"` � ��
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<br /> �. Appficant's Signature.� � Date � �' � q _J '
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<br /> Appfi�cant's`�ignature: � ,°` :-. f ;:� �:, -_•� _ , � � . • . ..
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<br /> :O:wner's�Signature :� _ � ::Date 1;� � .
<br /> Owner:s�S�nature.. - - `=Date. . `�.:�; .
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<br /> Last Updated: 6/27.L2011 5�": ' : . - . n.y
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