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City of C3rono <br /> Land Use Permit Appiication <br /> '�tp��= Application# r � 85 3 <br /> ���/�r� 2750 Kelley Parkway <br /> t Y Orono,MN 55356 Dete ReCeived: j�j r <br /> '� <br /> � � Main: 952-249-4600 ��' G' <br /> fax: 952-2d9-4616 Fee: <br /> ,a Meiling AdClress <br /> � � i � PA.Box 66 EScxOw#8�$ <br /> `� G� Crystsl Bey,MN 55323-0068 P8rtnit Fee � <br /> ��k�sxp�`�` �aes: <br /> Please complete. Applicant wilf be not�ed wi#hin 15 days as to the status of the application. <br /> Incomplete appllcations will not be placed on Planning Commission Agsndas. <br /> SITE LOCATION: 1 ,2� '�,ti�v�� 'D�wvE , oRo�v� , mN 5S 35� <br /> APPLICAN7/AGEWT INFORMATfON: <br /> Applicant Name: MPR'C -�-3��►�t�'L— i�4�fQt�.tb'C^ <br /> Phone (Primary): q52-22l —'-4q52 � <br /> Appficant Email: ��. � <br /> Address: 1►2 rP��E U�� '�RaV� City: {�oraU ZIP: 53�5� <br /> Agent Name: Agent's phone number <br /> Agent Email: Applicant is: Contractor omeowner �Circle One) <br /> PROPERIY OWNER INFORMATION: �(,check here if properry owner is sarrte as applicant <br /> Narrie: <br /> Phone(Primary): <br /> Mailing Address: City: ZIP: <br /> Email: ^ <br /> APPLICANT/AGENT ANDIOR OWNER: <br /> • Agree to provide all information required or requested by the Planning Department, <br /> • Agree to pay additional fees (staff time not covered in the original fee payment) �nd/or consultant expenses incurred in <br /> review of this application,and <br /> • Certify that the iniormation suppiied is trve and correct to the best of hishier knowledge. The applicarrt and owner <br /> recognize that they a�+e solely respor�ible for submitting a complete appllcatlon being awane that�pon falture to <br /> do so,the staff has no altemative but to reject It ur►tll lt Is complete or to recommend the request for denlal of the <br /> request regardless of Its potential merit <br /> • Adcnowledge the Escrow Agreement is Completed and signed. <br /> • The Owner hereby acknowledges and agrees to this applicatlon and fu�ther authorizes reasonable entry onto the property <br /> by City Staff,consultants, agents, Commission and Council Members for purposes of investigation and verification of this <br /> request. <br /> • Owr�er and/or AppUcant ackttowledge they must be pr+eser►t at all acheduled review meetings of the Planning <br /> Commission and Councll. li an applicant and/or owner is unable to attend a scheduled meeting, please make <br /> arrangements to have an authorized representative attend in plaoe of the applicarrt/owner and advise the City Pianner <br /> assigneti to your projed. <br /> ApplicanUAgerrt Signature: � -� �J Date: '�G <br /> Applicant/Age�Signature. Date: ���'f9-•fto <br /> � <br /> Property Owner Signature: Date: "t-!'�—1� D <br /> Property Owner Signatur+e: Date: �-Iq-1(� R <br /> ce►►a u�a�r;�r;o►�-+�r zoTs ,�Ut 2 0101 fi <br /> PeQe 2 � 3 $ � 3 <br /> CITY OF ORONO <br />