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City of Falcon Heights <br />Planning Application <br />r~ / ~~~ ; <br />Action Requested By: _ : <br />Name of Property Owner / ~~,~ <br />Phone (h) _ G57 - ~ r 5 - ~~?~ (:~r~h) (w) ~ 57- 4~ ~c - ~c~,~ r rT ~~-~~-> <br />Address ofProperty Owner i~ ~ > -5~~ i~~k ~ ~1. <br />Name of Applicant (if different) ~d~us ~ .~~;-t -- 1~;~:~~'•~~~-- o~ <br />Address. ~ Phone <br />Property Involved: <br />Address ~ ~~ ~ ~~ <br />Legal Description <br />Property Identification Number (PIN) __ ~~~i°~-~--//•-c~D.~~ .~ ~-.~-y -~~.-/~ -~,~;~~ <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 />^ Government/Institutional <br />^ Vacant Land <br />^ Lot Split ($250.00) <br />^ Site Plan Review ($100.00) - <br />Other (Please Specify <br />Qom. ~~0,~.~ Asa) <br />Brief Summary of Request.(applicant may submit letter to Planning Commission with <br />details of request): <br />t~ ~ <br />1 certify that aUstatement-s- on this application are true an orrec <br />• Signature f Property Owner (requ d) Signature of Applicant. ( applicable) <br />s~~ ~ ~. <br /> <br />S:\FORMS\BLDG PERMIT RPTG FORMS\PLANNING APPLICATION.doc 3/5/2003' <br />