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~~ <br />City of Falcon Heights <br />Planning Application <br />Action Requested By: <br />Name of Property Owner <br />Phone (h) <br />Address of Property Owner _ <br />Name of Applicant (if different) <br />Address <br />(w) <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 />• ^ Duplex/Two Family Dwelling <br />^ Multi Family Complex <br />Action Requested (NON-REFUNDABLE): <br />^ Business/Commercial <br />^ Government/Institutional <br />^ Vacant Land <br />^ Variance ($100.00) ^ Lot Split ($250.00) <br />^ Conditional Use Permit ($165.00) ^ Site Plan Review ($100.00) <br />^ Rezoning ($500.00) ^ Other (Please Specify) <br />Brief Summary of Request (applicant may submit letter to Planning Commission with <br />details of request): <br />I certify that all statements on this application are true and correct: <br />• Signature of Property Owner (required) Signature of Applicant (if applicable) <br />S:\FORMS\Zoning and Building Forms\PLANNING APPLICATION.doc 3/29/2005 <br />