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City of Orono Conditional Use Permit Application Street Address: Application # �� Q �p O A rO 2750 Kelley Parkway Orono, MN 55356 Date Received: ! / _ /110 . Main: 952-249-4600 Staff i€ fax: 952-249-4616 Fee. APPLICANT 1 AGENT INFORMATION: Applicant Name: Peter Eskuche Phone (Primary): 612-296-7575 Applicant Email: peter.eskudve@nor-son.com Address: 700 East Lake Street City: WltrrMW ZIP: Applicant is: <1 ontractor Homeowner (Circle One) Incomplete applications will not be placed on Planning Commission Agendas. SITE LOCATION: APPLICANT 1 AGENT INFORMATION: Applicant Name:` Phone (Primary): 2 Applicant Email: peter.eskuche-@nor-son.com Address: 700 East Lake Street City: Wayzata ZIP: 55391 Agent Name: Agent's phone number Agent Email: Applicant is: Contractor Homeowner (Circle One) PROPERTY OWN Name: Phone (Primary): Mailing Address: Email: 17 check here if property owner is same as applicant APPLICANVAGENT AND/OR OWNER: Agree to provide all information required or requested by the Planning Department, Agree to pay additional fees /staff time not covered in the original fee payment) and/or consultant expenses incurred in review of this application, and • Certify that the information supplied is true and correct to the best of his/her knowledge. The applicant and owner recognize that they are solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to reject it until it is complete or to recommend the request for denial of the request regardless of its potential merit. • Acknowledge the Escrow Agreement is completed and signed. The Owner hereby acknowledges and agrees to this application and further authorizes reasonable entry onto the property by City Staff, consultants, agents, Commission and Council Members for purposes of investigation and verification of this request. • Owner and/or Applicant acknowledge they must be present at all scheduled review meetings of the Planning Commission and Council. If an applicant and/or owner is unable to attend a scheduled meeting, please make arrangements to have an authorized representative attend in place of the applicantlowner and advise the City Planner assigned to your project. Applicant/Agent Signature: Date: I&- lG - lG Applicant/Agent Signature: - Date: Property Owner Signature: Date: 10116114 RECEIVIM Property Owner Signature: Date: / AUOcc CUP Application — January 2016 1 U Page 2 3864 CITY OF ORONO