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�i�y t�f �ron� <br /> Cc�nd�tfanaf U�� Pe�r��t App�icatiort <br /> 5rreer Address: qppucation# � � S(p <br /> �a A rO 2750 Kelley Parkwey <br /> i V l�rono,MN 55356 Date Received: -/ <br /> Statf: <br /> Main. 952-249�800 <br /> � . fax: 952-249-461 B Fee: <br /> APPLICANT!AGENT INFORIIAATlOM: <br /> Applicant Name: Pcter Eskucf,e <br /> Phpng(�rimary�; 812-296-7575 <br /> /���C�Rt�(Tla�: peter.eskuche(�nor-sas.com <br /> Addr@SS: ost a e rret City: Wfq'{+�R?► ZIP: ��°l <br /> Appticant is: 2��on�act�-Homeowner (Circ[e Onsj <br /> Incomplete applications will not be placed on Planning Comm�ssion Agendas. <br /> SITE LOCATION: <br /> APPLfCANT/AGENT iNFORMATION: <br /> Applicant Name: ��_ ���(�' <br /> Phone (Primary): �,I Z ZQb '7' S <br /> Appllcant Email: pere�.eskvcheQnor-son.com <br /> p►dd�65S: 700 East Lake 5treet CI�y: Wayzata ZIP: 5539i <br /> Agen#Name: Agent's phflne number <br /> Agent Email: Applicant is: Contractor Homeo�nrner {Circte One) <br /> PROPERTY OWNER INFORMATION: ❑check here rf property awner is same as appiicant <br /> Name: <br /> Phone(Primary): <br /> Mailing Address: 7 C+ . Zi�: <br /> Email: . <br /> APPLiCANT1AGENT AND/OR OWNER: <br /> • Agree to provide ail information required o�requested by the Plansung Department, <br /> • Agree to pay addl�onal fees (staff time not covered in the origfnal fee payment} and/or consultant expenses incurrec!� <br /> review of this applicatbn,and <br /> = Certify that tf�e in#ormation supp�ed fs true and correct to the best of his/her knowledge. The applicaM ar►d awn�r <br /> rocognize that they arQ solely respons(ble for submitting a canpiete applicatlon being aware that upon fatlure to <br /> do so,the staff has no alternative but to reject tt until it is complete or to recomrt�end tF�e request for dsnial of the <br /> request regardlesa of fts po�entiel msrlt. <br /> . Aclv�owledge the Escrow AgrsemeM is completed and signed. <br /> • The Owner hereby acknowledges and agrees ta this applicaBon and further authorizes reasoneble entry onto the property <br /> by City Staff, consultants, agents, Commission and Councfl Members for purposes of investigadon and veriFca�on of this <br /> request <br /> • Owner andlor Applicant acknowledge they must ba present at all schedulad raview m�tinga of the Planning <br /> Commission and Council. If an applicant and/or awner ks unable to attend a scheduled rneeting, please make <br /> arrangements to have an authorized representative attend in place of the applicanUowner and advtse the City Planner <br /> assigned to your project. <br /> ApplicanUAgent Signature: - _� __ Date: /d- tG - tG <br /> , <br /> ApplicanUAgent Signature: � - Date: <br /> Property Owner Signature: , Date: D L R,E�,���f�L <br /> Property Owner Signature: Date: / <br /> 1� <br /> Ci/P Appllcation—Jsnuary 2016 � � � � <br /> P�2 ,�j CITY O�ORONO <br /> ._8 <br />