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� PC Exhibit A <br /> City of �rono <br /> Variance Application <br /> Street Address: / �� <br /> �O A r 2750 Kelley Parkway ApPlrcation# <br /> �VO Orono,MN 55356 Date Reoeived. _ _� <br /> �Rain: 952-249-4800 Steff: C <br /> tax: 952-249-4818 Fee � <br /> ,� MafHrtg Address: EsC�Ow#&$ <br /> y �`s ; � PA.Box 66 �- - <br /> F� G� Crystal Bay,MN 55323-0068 PermR Fee <br /> �k�s H o�`� Notes <br /> Please complete. Applicant will be notified within 15 days as to the status of the application. <br /> Incomplete applicatfons wif! not be placed on Planning Commissfon Agenda. <br /> ,--� - r� �� /� ,,,/� <br /> SITE LOCATION: ,� �� �r P���l P t,� I/�.. V��f7 ///j4� �<5��� <br /> DESCRPTION OF REQUEST: �l�h.� a rd S e-�- �Ct �/Q,r 1 �L k <br /> � � e5�' <br /> (attached additional sheets as necessary) <br /> APPLICANT!AGENT!NF RMATI N: <br /> Applicant Name: C'� L.�� <br /> Phone(Primary}: — — l <br /> Applicant Email: � c��,., <br /> Address: (� v� rc.�,/ Ci ; z1P: �'�35� <br /> Appficant is: Contractor Homeowne (Gircle One) <br /> PROPERTY OWNER INFORMATIO�dc here ff property owner is same as applicant <br /> Name: <br /> Phone(Primary): �� -- <br /> Mailing Address: � City: ZIP• <br /> Email: ' <br /> APPLICANT/AGENT ANDIOR OWNER: <br /> • Agree to provlde all information required or requested by the Planning Department, <br /> • Agree to pay additional fees (staff time not covered in the original fee payment) and/or consultant expenses incurred in <br /> review of this application, and <br /> • Certity that the informaatf�on supplied is true and car�+ed to the best of hisR�er knowledge. The applicant and owner <br /> recognize that they are solely responslble for submltting a complete application belne aware that upon failure to <br /> do so,the staff has no altemative but to reject it untll it is compkte or to recommend the request for denlal of the <br /> request regardless of its potentlal mertt <br /> • Acknawledge the Escrow Agreement is�mpleted and slgned. <br /> • The Owner hereby ecknowledges and a8rees to this application and further authorizes ►Basonable entry onto the property <br /> by City Staff, consuftants, egents, Commission and Council Members fo�purposes of investigati� and verificetion of this <br /> request. <br /> • Owner and/or Appllcarrt acknowledge they must be preserrt at all scheduled review meetEngs of the Plannf�g <br /> Commission and Council. If an applicant and/or owner is unable to attend a scheduled meeting, please make <br /> aRangements to have an authorized representative attend in place of the applicanUowner and advise the Clty Planner <br /> assiAned to your project T•�, / <br /> 1 <br /> AppiicanUAgent Signature: IC� �"'"(�"`�" Date: �/ / /�(O <br /> / <br /> Applicant/Agent Signature: Date: <br /> Property Owner Signature: Date: <br /> PropertyOwnerSignature: N-d e ��9 Da#e: � � /� ��,�,�„� <br /> Varierx;e,4pplicetkn—May 2016 <br /> Page2 ��� � � ���x' <br /> # 386� <br /> CiTY OF ORONO <br />