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a <br />City ofi Falcon Heights <br />Planlning Application `SAY ~ ~~ <br />Action Requested By: _ <br />Name of Property Owner / ~~S • <br />Phone (h) X57 - ~ r5 - ~.~~ ~~~H) (w) ~;s"7- ctrc - ~~~ i t"j-~~~'~-~ <br />Address ofProperty Owner i'~~> 5~~-r~~~~ .~'v` ,~L®• <br />Name of Applicant (if different) ~d~~s L~ ~4 r~ - 1~,.~.- •~~ . <br />Address ~ Phone <br />Property Involved: <br />Address ~r~ ~ 7 Sr~~-G~i~s . .'~- <br />L.egat Description <br />Property Identification Number (PIN) ~-:~`i~~-.~--//~-~~~~ ~i-~-y~-~~--ji -~~~ <br />Present Use of Properly (check one): <br />^ Single Family Dwelling ~ BusinesslCommercial - <br />^ Duplex/Two Family Dwelling ^ Government/Institutional <br />^ Multi Family Complex ^ Vacant Land <br />Action Requested (NON-REFUNDABLE): <br />^ Variance ($100.00) ^ Lot Split ($250.00) _ <br />^ Conditional Use Permit ($165.00) ~ ^ Site Plan Review ($100.00) , <br />^ Rezoning ($.500.00) ~ Other (Please Specify <br />~ <br /> ~~~~~~,~ <br />Sa <br />Brief Summary of Request (applicant may submit letter to Planning Commission with <br />details of request): <br />,~ <br /> <br />~~.> /~ iL~ ~+ l.iG% //L~c~ mot. ~Gt'E <br />~~ <br />L~,.~r~~-sk'i~r~s,i~ 'TBr C~X~~,SS~~1 ~'~, <br />~ <br />t. <br />1~Li~c~itr7,Y1'l SEA ~;..vr~l ~ 'L <br />E~.-~. P"" ~. V..c..~_ CC~• , ~ ~~~~--E-°. i.~.P <br />. <br />c <br />_ <br />~/ v r <br />/certify that all statements on Phis applica tion are true and orrec <br /> <br /> <br />• Signature f Property Owner (requited) Signature of Applicant applicable) <br />S:\FORMS\BLDG PERMIT RPTG FORMSIPLANNING APPLICATION.doc 3/5/2003 <br />. ~~. <br />