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City of Falcon Heights <br />Planning Application ~~~~ ~ <br />Action Requested By: <br />Name of Property Owner RQger Miller <br />Phone (h) - (w) _ <br />Address of Property Owner H v I i h <br />Name of Applicant (if different) <br />Address <br />Phone <br />Properly Involved: <br />Address F N <br />Legal Description I V I 1 <br />Property Identification Number (PIN) 209?x„110024 <br />Present Use of Property (check one): <br />1~` Single Family Dwelling ^ Business/Commercial <br />^ Duplex/Two Family Dwelling ^ Governrnent/Institutional <br />• ^ Multi Family Complex ^ Vacant Land <br />ACtlon Requested (NON-REFUNDABLE): <br />Variance-($65:88} ~ %C~C~~ ~~~ ^ Lot Split ($250.00) <br />^ Conditional Use Permit ($165.00) ^ Site Ptan Review ($100.00) <br />^ Rezoning ($500.00) ^ Other (Please Specify) <br />Brief Summary of Request (applicant may submit letter to Planning Commission with <br />detail's of request): <br />I certifylbat afl sta <br />application are true and correct: <br />of Property Owner (required) <br />Signature of Applicant (if applicable) <br />