5.2. PCSR 10-25-2005 - Laserfiche WebLink

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. . . Planning Land Use Application Page 2 Owner Information Name: tLev ,1 V\ fvle-\ "at\d Address: ~H--'~ s..u:...h~ tB. Street Phone (w): S .Me :2 Fax: I prefer that my copy of staff reports be sent by: E-~ail ad~ess: -.k~\N\.eJ-a~~r~aj I (c/V\ $~ Q \\)~\t lVt}J C;~~ -"30 ' City State Zip Code SA-kS PhoneJ!I): s.A;v, Z 'CIa, Mai1U J=D E-mail~(a.eckone) , ~ '- Date: ,C1'-~~-OS Signature: Billing Information (if different from either applicant or owner information) c..., f\. Name: ~- '}OrOS Address: Street State Zip Code Phone (w): Signature: Agreement to Pay Costs of Review: It is the policy of the City of Elk River to require applicants for land use approvals and licenses to reimburse the City for costs incurred by the City in reviewing and acting upon applications, so that these costs are not borne by the taxpayers of the City. These costs include all of the City's out-of- pocket costs for expenses, including the City's costs for review of the application by the City's environmental Consultant, City 'Engineer, City Attorney, or other consultants, and may also include a charge for extra staff time to process particularly complex applications. The City will bill the applicant for these costs as they are incurred, and payment will be due within thirty (30) days of mailing of the bill. If payment is not received as required by this by this agreement, the City will suspend the application review process and may deny the application for failure to comply with the requirements for processing the application. Payment for costs will be required whether the application is granted or denied. The undersigned has received the City's policy regarding the payment of costs of review, understands that reimbursement to the City of costs incurred in reviewing the application will be required as set forth in the policy, agrees to reimburse the City as required in the policy and make payment when billed by the City, and agrees that the application may b(e denied for failure to reimburse the City for costs as provided in the2t1oli . / . /J / Signature: . LU' Date: C(!- ^o~O S , . "-. S:\PLANNING\Forms \Application Forms \Application Form Revised 01 240S.doc