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Formatted:Normal <br /> The undersigned has received the Cit:Ls policy regarding the payment of costs of review, <br /> understands that reimbursement to the City of costs incurred in reviewing the application <br /> will be required,agrees to reimburse the Ci as required in the policy and make payment <br /> when billed by the CiL3:,and agrees that the application may be denied for failure to <br /> reimburse the City for costs as provided in the polio <br /> Formatted:Normal <br /> Applicant Name Date <br /> Page 12 of 16 P 0 w E 0 E 0 9 1 <br /> ATURE <br />