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City of f=alcon Heights <br />Planning Application <br />Action Requested By: <br />~ooz ti o inn <br />~,~ ~dn„~-,- a „,i a~~ <br />Name of Property Owner ~ ~~ ~v~ <br />Phone (h) (~ 5 I - ~ ~I ~ - 1~ I ~5 (w) (~ 1 2- ~ ~ ~- 1 ~ ~q <br />Address of Property Owner I ~ y p /v. q. j f~ ~- rt r ~,, ~ r do ~~aT= <br />Name of Applicant (if different) <br />Address <br />Property Involved: <br />Address <br />Legal Description _ <br />Phone <br />Property Identification Number (PIN) <br />Present Use of Property (check one): <br />~ Single Family Dwelling <br />o Duplex/Two Family Dwelling <br />• o Multi Family Complex <br />o Business/Commercial <br />o Government/Institutional <br />o Vacant Land <br />ACtlon Requested (NON-REFUNDABLE): <br />q Variance ($100.00) <br />o Conditional Use Permit ($165.00) <br />o Rezoning ($500.00) <br />o Lot Split ($250.00) <br />o Site Plan Review ($100.00) <br />o Other (Please Specify) <br />Brief Summary of Request (applicant may submit letter to Planning Commission with <br />details of request): <br />~.. ,. n C` <br /> <br />..~! ~ <br />1 certify that all s a e ents on this application are true and correct: <br />~___-.-~ <br />Sign ure of Property Dwner (regruired) Signature of Applicant (if applicable) <br />S:\FORMS\BLDG PERMIT RPTG FORMS\PLANNING APPLICATION.doc 3/5/2003 <br />