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Name: <br />Street Address: <br />I City, State, ZIP: <br />IHome Phone: <br />IEmail: <br />Property Owner Information <br />(If different than Applicant) <br />First Minnesota Bank <br />11431 Jefferson Court N <br />Champlin, MN 55316 <br />N/A • <br />chuckb@firstmnbank. corn <br />IWork Phone: <br />IFax Number: <br />1763-488-1568 <br />I763-488-3735 • <br />Please provide a detailed description of your request and attached'a copy of a scaled site plan <br />See attached narrative and plans. <br />A. "Land Use Sign" will be placed on the.Subject Property to allow Ramsey Residents the <br />opportunity to obtain information about your request. <br />Applicant Signature <br />Printed Name <br />Title <br />(Troy Halverson <br />iie5 / v <br />r., <br />Date ( Date <br />/0 <br />I understand that the application fee Is non-refundable. 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 any applicable regulatory agencies for this Land Use Application. <br />Co -Applicant Signature <br />Printed Name <br />Property Owner <br />Signature <br />Title <br />Property Owner <br />Signature <br />Printed Name First Minnesota Bank Printed Name <br />Title Title <br />Date December '15, 2016 Date <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 />Charles C. Blair <br />Executive Vice President <br />