HomeMy WebLinkAbout16-3851 ExF1 APPCity of Orono
Variance Application
5treetAddress:
Application #
2750 Kelley Parkway
Orono, MN 55356
Date Received:
Staff
Main: 952-249-4600
fax: 952-249-4616
Fee:
Mailing Address:
Escrow # & $
P.O. Box 66
Crystal Bay, MN 55323-0066
Permit Fee
Notes:
Please complete. Applicant will be notified within 15 days as to the status of the application.
Incomplete applications will not be placed on Planning Commission Agenda.
SITE LOCATION: �L4 t 3 CC V-nAC1.1 5-t`
DESCRPTION OF REQUEST: Ica -co,-Ar1A %'1J 9&*015A- 1a9...4jk.-� o,4r-k'-1 ,Q,,AS 11V1tcf rb0.11 rxd+c��p
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(attached additional sheets as necessary)
APPLICANT / AGENT INFORMATION:
Applicant Name: IDeir.r '%kqt ,
Phone (Primary): 2,_
^ Applicant Email:
Address: +'2-.413 CG►nn4r1++ '5t" City: p�-bv?0 zip:
Applicant is: Contractor
(Circle One)
PROPERTY OWNER INFORMATION: Xcheck here if property owner is same as applicant
Name:
Phone (Primary):
Mailing Address: _ _ City: ZIP:
Email: —
APPLICANTIAGENT 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 applicant/owner and advise the City Planner
assigned to your project.
ApplicanttAgent Signature: � ��'t '� Z� _ Date: oo -MA%'P
Applicant/Agent Signature: Date:
Property Owner Signature: ��1 �-_ Date:
Property Owner Signature: Date: RFCFIVF
Variance Application — May 2016
Page 2
JUL 18 2016
# 3851
CITY OF ORONO