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Page 2 of 2 <br /> IV. Property & Contractor Information: <br /> Street Location/Address of Property: 1546 16th Terrace NW, New Brighton, MN 55112 <br /> Property Identification Number (PID): 203023220025 Zoning District: R-1 <br /> Legal Description (From Deed or Certificate of Title): gPlease see attached <br /> Lot: Block: Addition: <br /> Property described is by: XAbstract ❑ Torrens—Certificate #: <br /> Location of Certificate: <br /> Architect (if applicable): N/A Phone: <br /> Surveyor/Engineer(if applicable): Frank Cardarelle Phone: 952-941-3031 <br /> Builder(if applicable): J & J Remodelers Phone: 612-710-4388 <br /> V. Main Contact Person <br /> Property Owners <br /> ❑ Other (if other, please fill out the information below) <br /> Title(Position or relation to property owners): <br /> (name) (address) (st) (zip) <br /> (phone#) (fax#) (email) <br /> VI. Notice of Fees <br /> As set forth in the City Fee Schedule and pursuant to applicable law,the property owner shall be responsible to reimburse the city for all related <br /> miscellaneous costs incurred pursuant to the processing of this application. Note that these reimbursements may exceed the amount of the original land <br /> use application fee. Such expenses may include,but are not limited to,direct city payroll and overhead costs,fees paid to consultants and other <br /> professionals,and the cost of printing,mailing,and supplies. These miscellaneous fees are due immediately upon notification by the City. The City shall <br /> provide,upon request,an itemized statement of the various expenses incurred by the City. The City may withhold final action on a land use application <br /> and/or rescind prior action until all miscellaneous fees are paid. The City may require additional deposits,if deemed necessary. The property owner <br /> agrees to allow city staff and commission members to access the property per this application for inspection. <br /> I acknowledge that I have read the above statement and fully understand that I am responsible for all costs incurred by the City in the processing and <br /> reviewing of this application <br /> Property Owners Signature: Date: �/1'1(2-b <br /> ADMINISTRATIVE USE ONLY: <br /> Date Application Received: PC Date: <br /> Fee Paid: CC Date: <br /> Escrow Paid: <br /> Receipt Number: Form Last Updated 10.18.18 <br />