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•~ <br />City of Falcon Heights <br />Planning Application <br />Action Requested By: p ,, _ <br />Name of Property Owner ~U~~'i7 ~ ~e l ~/lr~~~CiL1 ~i/ _ <br />Phone (h) ~ ~/- %/) ~ - ~~~ ~,~ (w) <br />Address of Property Owner D ~~ / < <br />Name of Applicant (if different) ('~~t~~r ~tW ~, ' <br />Address <br />Property Involved: <br />Address <br />Legal Description _ <br />D ~~ <br />Property Identification Number (PIN) (~ •~y . Z~ ~ ~'~ ~ (~ is'~ <br />Present Use of Property (check one): <br />^ Single Family Dwelling <br />^ Duplex/Two Family Dwelling <br />• ^ Multi Family Complex <br />Action Requested (NON-REFUNDABLE): <br />.Variance ($100.00) <br />^ Conditional Use; Permit ($165.00) <br />^ Rezoning ($500.00) <br />~ Business/Commercial <br />^ Governmentllnstitutional <br />^ Vacant Land <br />^ Lot Split ($250.00) <br />^ Site Plan Review ($100.00) <br />^ Other (Please Specify) <br />Brief Summary of Request (applicant may submit letter to Planning Commission with <br />details of request): <br />~ ~rarri aln c~ ~ <br />~~ A i~'I.a 1 °l~t~C.r~t rTwvYt ~i11 ~ i~'1f'e <br />~~ ~~~ s; ~~ ~ ~ <br />s ~3c <br />`~~~' ~~'~ ha~-~~ uy~r~.~ ~es~-~ Male ~t/l,~f~tte ~m 5: ~e ~' ~. ~a~c~Z~ r~.~ . <br />1 certify that all statements on this application are true and correc . <br />. ~~ L ' ~ I~/ ~~G <br />• Signature of Properly Owner (required) Signature of Applicant (if applicable) <br />S:\FORMS1Zoning and Building Forms\PLANNING APPLICATION.doc 3/29/2005 <br />