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PC Exhibit A <br /> C i ty of C3 ro n o <br /> Variance Application <br /> street,address: pPP�ication# I lo �3�75 <br /> n o/,T� 2750 Kelley Parkway <br /> I� { V Orono,MM 55356 Date R@Ceived: -Za-( <br /> Main: 952-249-46Q0 <br /> Staff: � <br /> � fax: 952-249-4618 Fee: p� <br /> ,.� � ' � y Matling.4ddress_ EsCrow#8�$ <br /> y� � � P.O.Box 66 <br /> r�����G,' Crystal Bay,MN 55323-0088 Permft Fee <br /> �S H 0 Notes: <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete applications will not be pisced on Ptanning Commissian Agenda. <br /> ._ � , , ,` <br /> SiTE LOCATION: '`' "� -�., ,�" ' _ ��_ � � ;J� � <br /> �� „ <br /> DESCRPTION�F REQUEST: <br /> (attached additional sheets as necessary) <br /> APPUCANT 1 AG�T�N�ORMAl1�N; Q S����� �;�� <br /> Applicant Name: � � <br /> Phone(Primary): `?�,3 . -7 _ . <br /> Applicant Email: '� a,, S , <br /> Address: p o, i..� Cit : ZIP: `�jSq� <br /> Applicant is:�,Contractor _ Homeowner (Circle One) <br /> PRQPER7Y OWNER INFORMATION: q check here!f property rtimer is sam�. s applicant <br /> � <br /> Name: _:.�.�_ �—`.�- r. � ,,,r � �-�� � , � <br /> Phone(Primary): - _~ _ `�-�o� --c� `�- S 1- .c� �-lo <br /> Maifing Address: ( a Cit ZIP: �Z. <br /> Email: � �,.� _„__ ra. c'�+�-�o� � c' cs��n <br /> �_ T _ T . <br /> ( J .. <br /> APPLlCANT1AGENT ANp/0R OWNER: <br /> • qgree to provide all informatlon required or requested by the Planning Departrnerrt, <br /> • Agree to pay additional fees (staff time not covered 1n the original fee paymerrt}and/or oonsultant expenses incurred ln <br /> revlew of thls appllcation,and <br /> • Certify that the iMormation supplied is true and co�ect to the besf of his/her knowledge. The applk:ant and owner <br /> recognaQ that they are solely reaponaible for submltting a complete application befr�p awarQ that upon falture to <br /> do so,the staif has no alt,ernative but to roject It untll it Is complete or to recommend the request for denial of the <br /> request repardless of its pobentiai merit <br /> • Adcnowledge the Escrow qqreement is oompleted and signed. <br /> • The Own�hereby acknowledges and agr�s to this applic�tion and further authorizes reasonable entry onfo the property <br /> by City Staff, consultants, agents, Commission and Council Members for purposes of investigation and verification of this <br /> request. <br /> • Owner andlor Appllcant ackno�vledge they must be present at all scheduled review rr�eetioQs of the Planning <br /> Commission and Council. !f an applicarrt and/or owner is unable to attend a scheduled meeting, piease make <br /> arrangements to have an authorized representative att d in place of the applicanUowner and advise the City Planner <br /> assigned to your project. � <br /> Applicant/Agent Signature: t ' Date: � �C O ' L,0 <br /> Applicant/Agent Signature: Date: <br /> Property Owner Signature; � Date: a �� � �Q <br /> Property Owner Signature: Y Date: a o�O p <br /> Variance Appliccafron—May 2016 <br /> �Z SEP 21 201fi <br /> t� � � � � CIIY 4F ORf?NO <br />