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�G'. ��Iv t l � <br /> � ' Gity of Clrt�no <br /> �ariance� Application <br /> 5treef Address: Applica6on# ` �"Z� <br /> ��J�r� 2750 KeHey Parkway <br /> � �s Orono,MN 55356 Date Reaeived. Zt <br /> Main: 952-249-4600 <br /> Steff <br /> fax: 952-249-4616 Fee " Z� <br /> � � � h9ailinp Add►ess: Escraw#8�$ � <br /> � P.O.8ox 66 <br /> '� G� Crystal Bay,MN 55323-0066 Permd Fee <br /> t�xEs x o�`` tvotes <br /> P�ease campiete. Applicant will be noti#�ed within 15 days as to the staius of the appiication. <br /> Incomplete applications wil[�ot be placed on Planning Commission Agenda. <br /> 3lTE LOCATION: � t�i-�''t <br /> DESCRPTION OF REQUEST: <br /> (attached additional sheets as necessary) <br /> APPLICI�NT f AGENT INFpRMATION: <br /> Applicant Name: �cali,�,��,�r�;}7�.1 i�,� �(dL�'�� <br /> Phone(Primary): ��2��� -b�.q. <br /> Applicant Email: ► � � <br /> Address: �j Ci : Z9P: , <br /> Applicant is: Contractor H�meovme (Circfe One) <br /> `OPERTY OWNER INFORMATION: I�check here if properly owner is same as applicant <br /> ._ame: <br /> Phone(Prirnary): <br /> Maiiing Address: City: ZIP: <br /> Emaril: <br /> APPLICANT/AQEWT ANDIOR OWNER: <br /> • Agree to provide all information required or requested by the P(anning Departmerrt, <br /> • Agree to pay additional fees (staff time not covered in the original fee payment) and/or consultant expenses incurned � <br /> review of this application,and <br /> • Certify that the irfiormation suppbed is true and corr�et.�t to the best of his./her know9edge. The appifcant and owner <br /> reaognite tliat they ar+e solefy rosponsible for submit�ing a aomplsba applicatlon boYr�aware that upon fallure to <br /> do so,the staff has no altemattve but to reJect it ur�til It is complebe or to recommand the request for denial of the <br /> request r+sgardless of it�potientfal merit. <br /> • Acknowledge the Escrow Agreement Is completed arxi signed. <br /> � The Owner hereby acknowkedges and agress to this application and furtt�er auihorQes reasonable entry onto the property <br /> by City Staff, consultants,agents, Commission and Council AAembers for pwposes of investigation and verification of this <br /> request. <br /> • Owner andlor Applicant acknowl�dgs thsy must be present �t a11 �duled revlew mcetlngs of the Planning <br /> Commisslon and Councfl. If an applicant and/or owner is unable to attend a scheduled meeting, please make <br /> arrangemerrts to have en suthorized representative attend En pface of the applicaMlowner and advise the City Planner <br /> assigned to your project. <br /> App�icanUAgent Slgnature: w-- �=�"�._,�._._.— <br />