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6. NELSON - MENARDSCOO P~ Case Number. ~ ~ ~ ~ - ~ General Punning Application Temporary Sales/Storage of Fireworks ~ , ~ o. Propert~r information Address: I~~~ ~ ~~~JS ~/~~ Parcel Number: 75 - ~~/- ©~~ ~~ ~J2~-vim, ~ .v ss3 3 0 Legal Description: (attach if necessary) ~,ppiicant information ~/~d'~/!Z~ ~'~~~'~~/TGG~~/.7~.~• ~l~U~S'/~/G~~~C' Name: ,{ dG~st/ Td~ ~ _ /~ E-mail address: (.~6l~sc~/y~GSON ~ ~'/f1~-rL, ~Qyy( Address: ~f~ll~o ~oA,~G~~ G6I[-~!?~T ,E~ IZ~ Cf// ~~20/ street ~ stage z;p cpae Address of Fireworks Sales: _! 9,$-~-/ ~U/~ltJ S S~~ ~[f~/ ,e~ ~U~ `jf /(~ Dates of Fireworks Sales:. C °- ZP/ - Y I ~~~ti "~ - S' --1/ Phone: Business:7~3'~~/d'~ 7G~iFag: xome/cell: ~G-3 -cfY~- 7lv ~ Signature: Date; ~~ Owner information ~i~" ' ame• ~~~~~~~ ~(i E-mat Address• Address: SI t9 / ~11~~li/~ll~ ,t7/Z, ~~ L~/,C.~ G[/j 5~~~~~ Street City Stare Zip Code ~~ Phone (w): Fax: Phone (h): Signature: Date: escription of Project Please describe pour project/reason for your request. If necessarq, attach a written narrative. m~y Tt~ ~l~~/~ ~o~' site Pian A site plan of the proposed location and layout of the temporary structure and its surroundings must be submitted. [~ Site Plan completed and attached to application. Agreement to Par 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 fox 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-packet costs for expenses, including the city's casts far review of the application by the cup's environmental consultant, city engineer, city attorney, or other consultants, and may also include a charge for extra staff time to process partic«larly complex applications. The cite w~l bi11 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 agreement, the city will suspend the application review process and may deny the application for failure to comply with the requirements fox 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 polity and make payment when billed by the city, and agrees that the application may be denied for failure to reimburse the .city for costs as provided in the policy. Fireworks are aegulated by Minnesota Statutes 624.20-(24.25. Ia additioa to these state laws, all display, sales, storage, and use of fireworks shall coffiply with Elk River City Ordinance Section 22 231 through 2~ 253. I understand and agree to comply with all the provisions of this application and the requirements of the issuing authority. I am ? 8 years of age or older. I bereby submit application for an Elk Diver Saks ~Fin7vorks lacense and attest that all reported information ' tn. ~ accrtrate. ~ Signature of applicant: Date: CS . ~• G~ OFFICE USE ONLIT The Fire Department has conducted a site check on the aforementioned applicant. D Approved ©Dnnied Commerrtsj Conditions• Signature of Fire Chief jDesignee: Date: Council Approval Granted: ~~ /~i% lt~1111i1~tN111 V ~V ati {~ Vl e ~~ ~~ wy ~~ ~~ ~~ ~~ r~ ~~ c W 0 .. s s w a ^1 70 A ti~ 1 ~~ ~• a ssa :~ ~~~ :c