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Property Owner Information <br />(If different than Applicant) <br />Name: Avnb\Sc,, CO\M4U1 <br />Street Address: 440 \kYiV LG; .. <br />City, State, ZIP: AY, G\6V-Q ) M N C>5 <br />Home Phone: Work Phone: <br />---� "7ra 3 -- 323 -5 (0 9 3 <br />Email: ,evYy c � Cp cFax Number: <br />rrn,vF,, <br />Please provide a detailed description of your request and attached a copy of a scaled site plan <br />A- -A-c► t� vne J wo.- 5 (M�n)) aC. sclA C <br />1 . S <br />t763/1elD »'\ L$ Y_^d� U QY`�Y Jc 54c c cj <br />'Cr\ b� P\I PArtrl-Ev}(:)wo r) S4-c), r(Nye �Ik1,1)j? �-ln ctnc\ Ckc-ZS;-v\ <br />A "Land Use Sign" will be placed on the Subject Property to allow Ramsey Residents the <br />pof 4nity to obtain information about your request. <br />Applicant Signatureji <br />?fe VOjn \ 01/41n8q <br />VP) Phu Swpfly <br />gUS 1 Ytes15 N:\10 o f YYVY \- <br />I understand that the application fe4is nontrefu able. All costs associated with the processing of this application are the <br />responsibility of the applicant whether this application is approved or denied. Any excess of escrow account deposits over <br />expenditures will be refunded at the time of account closure. I also understand that as the applicant, it is my responsibility to obtain <br />all other permits or licenses required by -airy pplli le regulatory agencies for this Land Use Application. <br />Printed Name <br />Title <br />Date <br />Property Owner <br />Signature <br />Printed Name <br />Title <br />Date <br />0-6,14.a <br />�2K Y Sornc.` <br />Co v) Aarnivi\5--)-foh,( <br />" -7 <br />I hereby certify that I am the fee title owner/contract for deed vendee of record for the above -mentioned property. Failure to prove <br />ownership may void any agreements entered into the City and I will be held liable for any and all costs incurred by the City. <br />Co -Applicant Signature <br />Printed Name <br />Title <br />Date <br />Property Owner <br />Signature <br />Printed Name <br />Title <br />Date <br />