Application Form - Signatures\uthentl5lgn IV: 05337G61:t1330-1-0I I-A5h1-000WABA9962
COMMUNITY DEVELOPMENT DEPARTMENT
Planning Division — 7700 Market Boulevard
Mailing Address — P.O. Box 147, Chanhassen, MN 55317
Phone: (952) 227A 100 / Fax: (952) 227=1110
Submittal Date.
2025-05-16
APPLICATION FOR DEVELOPMENT REVIEW
PC Date: 2025 O6 17
CC Date: 2025 07-14
60-Day Review Date: 2025 07-15
ApplicationSection Ia. apply)
(Refer to the appropriate Application Checklist forrequired submittal information that must accompany this application)
❑ Comprehensive Plan Amendment ........................a $700
❑ Conditional Use Permit (CUP)
❑ Single -Family Residence ................................ $400
❑ All Others......................................................... $600
❑ Interim Use Permit (IUP)
❑ In conjunction with Single -Family Residence.. $400
❑ All Others......................................................... $600
❑ Rezoning (REZ)
❑ Planned Unit Development (PUD) .................. $750
❑ Minor Amendment to existing PUD................. $100
❑ All Others.,. ENE ME a namonsammma $600
❑ Sign Plan Review ................................................... $150
❑ Subdivision (SUB)
❑ Plat 3 lots or less ........................................... $500
❑ Plat over 3 lots.... I No &goal onsommompmomm 0 a 6*0 esdammomma4mvpP$1250
❑ Metes & Bounds (2 lots) ................................ $300
❑ Consolidate Lots ............................................ $150
❑ Administrative Subd. (Line Adjustment) .......1$150
❑ Final Plat ............................................ $700*
❑ Vacation of Easements/Right-of-way (VAC)........ $300
(Additional recording fees may apply)
❑� Variance (VAR) .................................................... $200
❑ Wetland Alteration Permit (WAP)
❑ Single -Family Residence................. 0 d 0 a a a a a a a 2 a a 0 $150
❑ All Others ....................................................... $275
❑� Site Plan Review (SPR) ❑Appeal of Administrative Decision ....................... $200
❑ Administrative.................................................. $100
FNI Residential/Commercial/Industrial Districts.. $750** ❑ Zoning Ordinance Amendment (ZOA) ................. $500
NOTE: When multiple applications are processed concurrently, the appropriate fee shall be charged for each application.
■❑ Notification Sign (City to Install and remove)...... Moto a a mommum 0041 smoomwosw $200
❑ Escrow for Recording Documents (check all that apply)........................................................................... $ per document
❑ Conditional Use Permit - $50 ❑ Interim Use Permit - $50 Site Plan Agreement an $85
❑ Wetland Alteration Permit - $50 ❑ Easements ( easements) - $85 ❑ Vacation - $85
0 Variance an $50 ❑ Metes & Bounds Sub (2 deeds) - $250 ❑ Deeds - $100
TOTAL FEE: 11285
*Includes $450 escrow for attorney costs.
**Additional escrow may be required for other applications through the development contract.
Section 2a Required Information
Description of Proposal: 34 bed memory care assisted living facility
Property Address or Location: 1620 Arboretum Boulevard
Parcel #: 250 MMMM, , 2501 Legal Description: See Attached Survey
Total Acreage: 3.50
Wetlands Present?
Present Zoning: R-16
Present Land Use Designation: R-16
Existing Use of Property: Vacant
Fv`1 Check box if separate narrative is attached.
✓❑ Yes ❑ No
Requested Zoning:
R-16
Requested Land Use Designation: R-16
Wtnenttsign ID: Ob33/(:6t-tH3U-F011-ASFI-UUUL)JA8A9962
Section
3: Property
Owner
and
Applicant
Information
APPLICANT OTHER THAN PROPERTY OWNER: In signing this application, I, as applicant, represent to have obtained
authorization from the property owner to file this application. I agree to be bound by conditions of approval, subject only to
the right to object at the hearings on the application or during the appeal period. If this application 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 information and exhibits submitted are true and correct.
Name: Fusion AE Contact: Andrew Altstatt
Address: 6442 City West Parkway, Suite #300
City/State/Zi p: 55344
Email:
Signati
Phone: 952-767 1954
Cel I: 651-324-2778
Date: 2025-05-13
PROPERTY OWNER: In signing this application, I, as property owner, have full legal capacity to, and hereby do,
authorize the filing 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 that the information and exhibits submitted are true and correct.
Name: Lighthouse Homes, LLC
Address: 168 Pioneer Trail, No. 129
City/State/Zip: Chaska, MN 55318
Email:
Signati
Contact: Deena Laugen
Phone: -
Cell: 612-643-1703
Date: 05/14/25
This application must be completed in full and be typewritten or clearly printed and must be accompanied by all
information and plans required by applicable City Ordinance provisions. Before filing this application, refer to the
appropriate Application Checklist and confer with the Planning Department to determine the specific ordinance and
applicable procedural requirements.
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.
PROJECT ENGINEER (if applicable)
Name: Civil Site Group
Address: 5000 Glenwood Avenue
City/State/Zip: Golden Valley, MN 55422
Email: amelby@civilsitegroup.com
Contact: Anders Melby, PE
Phone: 612-615-0060 x 718
Cell: 651-233-6536
Section 4: Notification Information
Who should receive copies of staff reports? *Other Contact Information:
❑� Property Owner Email deena@edenspringsmn.com Name:
❑■ Applicant Email aaltstafl@fusion-ae.com Address:
0 Engineer Email amelby@clvilsltegroup.00m City/State/Zip:
❑ Other* Email Email:
INSTRUCTIONS TO APPLICANT: Complete 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 and payment. SUBMIT FORM to send a digital
copy to the city for processing.