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Property Owner Information <br />(If different than Applicant) <br />Name: <br />First Minnesota Bank <br />Street Address: <br />11431 Jefferson Court N <br />City, State, ZIP: <br />Champlin, MN 55316 <br />Home Phone: <br />N/A <br />Work Phone: <br />763-488-1568 <br />Email: <br />chuckb@firstmnbank.com <br />Fax Number: <br />763-488-3735 • <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 />7/ <br />Co -Applicant Signature <br />Printed Name <br />Troy Halverso <br />Printed Name <br />Title <br />/ . <br />Pre,50,41----- <br />Title <br />Date <br />. <br />/�-/5'�C�i <br />Date • <br />. <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 />Property Owner <br />Signature <br />Property OwnerC?).241e4D <br />Signature <br />Printed Name <br />First Minnesota Bank <br />Printed Name <br />Charles C. Blair <br />Title <br />Title <br />Executive Vice President <br />Date <br />December '15, 2016 <br />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 />