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City of Falcon Heights <br />Planning Application <br />Action Requested By: ~ ~ ~ - <br />Name of Property Owner ~-~-~~~ ~~~ Z- <br /> <br />Phone (h)- ~1 (Q~ Lz ~3~~ (w) 9 (~~ c~ `~~ <br />Address of Property Owner- f ~~~ f'~S U t~12r~ <br />Name of Applicant (if different) ~~ <br />Address '~' Phone ~-~ <br />Property Involved: <br />Address C ~~ ~S(3U <br />Legal Description ~ ~ ~ S <br />~l <br />a ~~ . Lo ~- <br />. Property Identification Number (PIN) j~ v~q - o?~ ~ 3 2. ~ C~:~'/orZ <br />Present Use of Property (check one): <br />Single Family Dwelling <br />^ Duplex/Two Family Dwelling <br />^ Multi-Family Complex <br />A1ction Requested: NON-REFUNDA~B~LE~ <br />?~1 Variance ($6tr.6~j'~~~ ~ ~'"I`~`~~' <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 />Brief Summary of Request (applicant may submit letter to Planning Commission with details <br />of request): <br />P~aY2 b ~a~c ~~ r~x~m/ C~'[.L IVb~-G°CC~ ~(~.P ~ .~t'C.,K ~,f2d (k~~ SlitbyiCL~ <br />l certify that al! statements on this application are true and correct: <br />Signature of Property Owner required) Signature of Applicant (if applicable) <br />