Application for Development Review 22-177L-11 Mv
APPLICATION FOR DEVELOPMENT REVIEW
submittat Date: lL'l 6'ZL PC Date l-17 -23 ccoatet L-*-)L
CITY OI CIIII.IIIASSII{
60-Day Review Date 2 lzz
Section 1: Application Type (check all that apply)
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n
(Refet to the appropdate Application Checklist for
Comprehensive Plan Amendment.
E Minor MUSA line for failing on-site sewers .....
Conditional Use Permit (CUP)
! Single-FamilyResidence
required submindl inlomation thdl must accompany this applicdtion)
$600 E subdivision (suB)
$1OO E Create 3lots or less
! Create over 3 lots....( lots)
E Metes & Bounds (2 lots).................
! Consolidate 1ots......................
E Lot Line Adjustment...................
E Final Plat......................
(lncludes $450 escrow for attorney costs)*
'Additional escrow may be required for other applications
through the development conltact-
n Vacation of Easements/Right-of-way (VAC)........ $300
(Additional recording fees may apply)
E Variance (VAR).......... .. . ................................... $200
E Wetland Alteration Permit (WAP)
! Single-Family Residence............................... $150
E Att others...... .................... $275
E zoning Appea|.......................-..-........................... $200
! Zoning Ordinance Amendment (ZOA)................. $500
XqIE: Wher multiple applications ar3 p.ocessed concuronuy,
the appropri.te f6o shall bo chargsd for e.ch application.
... $200
$3 per address
$325
$425E Alt others
E lnterim Use Permit (lUP)
E ln conjunction with Single-Family Residence.. $325
! Al otners...... ...................... $425
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Rezoning (REZ)
E Phnned Unit Development (PUD).................. $750
n Minor Amendment to existing PUD................. $100
E All others...... ...................... $500
Sign Plan Review................................................... $150
Site Plan Review (SPR)
E Administrative ..................... $100
E Commercial/lndustrial Districts*...................... $500
Plus $ 10 per 1,000 square feet of building area:( thousand square feet)
'lnclude number ot glglEg employeesi
'l clude number of4g!! employees:
E Residential Districts......................................... $500
Plus $5 per dwelling unit ( units)
E Notification Sign lcty to instattand remove).............
! Property Owners' List within 500' lCity to generate after pre-application meeting) ....
I Escrow for Recording Docu
E Conditional Use Permit
E Vacation
ments (check all that app
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lnterim Use Permit
Variance
...................... $50 per document
n Site Plan Agreement
E Wetland Alteration Permit
! Metes & Bounds Subdivision (3 docs.) n Easements L- easements)<a< a a)
$4gEd0E Deeds
TOTAL FEE:
Section 2: Required lnformation
Description of Proposal
5621 Minnewashta Parkway Excelsior, MN. 55331Property Address or Location
Parcet #: 254800030
51
. Single-Family Residential District (RSt Requested Zoning Single-Family Besidential District (RSF)
Present Land Use Designation:Residenlial Low Densit Requested Land Use Designation Residential Low Density
Existing Use of Property:Primary residence
Total Acreage:
Present Zoning
COMMUNITY DEVELOPMENT DEPARTMENT
Planning Division - 7700 Market Boulevard
Mailing Address - P.O. Box 147, Chanhassen, MN 55317
Phone: (952) 227-1 100 / Fax: (9521 227 -1110
$
@.ja_ addresses)
Legal Description: 002
Wetlands Present? E Yes E tto
Echeck box if separate narrative is attached.
APPLICANT OTHER THAN PROPERTY OWNER: ln signing this application, l, as applicant, represent to have obtained
authorization from the property owner to file this application. I agree to be bound by conditions of approval, subiect only lo
the right to object at the hearings on the application or during the appeal period. lf this applicalion has not been signed by
the property owner, I have attached separate documentation of full legal capacity to file the application. This application
should be processed in my name and I am the party whom the City should contact regarding any matter pertaining to this
application. I will keep myself informed of the deadlines for submission of material and the progress of this application. I
further understand that additional fees may be charged for consulting fees, feasibility studies, etc. with an estimate prior to
any authorization to proceed with the study. I certify that the informalion and exhibits submitted are true and conect.
Name:Conlact:
Phone:Address
City/Statezip
Email:
Signature
PROPER,IrY OWNER: ln signing this application, l, as prope(y owner, have full legal capacity to, and hereby do,
authorize the liling of this application. I understand that conditions of approval are binding and agree to be bound by those
conditions, subjeCt only to the right to object at the hearings or during the appeal periods. I will keep myself informed of
the deadlines for submission of material and the progress of this application. I further understand that additional fees may
be charged for consulting fees, feasibility studies, etc. with an estimate prior to any authorization to proceed with the
study. I certify thal the information and exhibits submitted are true and correct.
Name:Keri & Cordell Mack
6621 Minnewashta Parkway Phone:
City/State/Zip:
Email:
Excelsior, MN- 55331 Cell 612-597-8657
cordell.mack@vmghealth.com Fax:
Signature CordellMack Date 12t15t22
PROJECT ENGINEER (if applicable)
Address
Contact:
Phone:
Cell:
Fax:
Name:
City/State/Zip
Email:
Cell:
Fax:
E Property Owner Via: E Email
$ nppticant Via: EIEmail
fl Engineer Via: E_Email
EF, other' via: Ef Email
Who should receive copies of staff reports?*Other Contact lnformation:
Address:
City/Sta
Email:
PRINT FORM
! Maited Paper copy Name h
SUBTIIT FORM
trn Mailed Paper Copy
Mailed Paper Copy p
E lr,,taiea Paper Copy
INSTRUCTIONS TO APPLICANT: Com plete all necessary form fields, then select SAVE FORM to save a copy to your
device. PRINT FORM and deliver to city along with required documents an
SAVE FOBMcopy to the city for processing.
d payment. SUBMIT FORM to send a digital
Address:
noto'
-
Contact: _
This application must be completed in full and must be accompanied by all information and plans required by
applicable City Ordinance provisions. Before tiling this application, refer to the appropriate Application Checklist
and confer with the Planning Department to determine the specitic ordinance and applicable procedural
requirements and fees.
A determination of completeness of the application shall be made within'15 business days of application submittal. A
written notice of application deficiencies shall be mailed to the applicant within 15 business days of apPlication.
Section 3:and
Section 4: Notification lnformation