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11/22/2905 11;19 6517664046 <br />CITY LITTLE Cit-ADA <br />Little Canada, Minnesota <br />APPLICATION FORM <br />PAGE 1 <br />PAID 9 c <br />Rec. No,.___ <br />Cerra ahensive Phil Alt1 11LJ ,I Nl <br />• Gpndrtional Use Permit <br />Zoning District Amendment <br />___ Variance <br />TPNT Amendment <br />Other <br />Applicant_ )` .1j cr <br />(Name) / <br />Owner <br />(Name) <br />. Planned Unit Development <br />Plan Review <br />(Address) (Phone) <br />Prmfrnl•ty LvcdLive! (SLreat Address and Legal L) t IpttQnl1 <br />(Address) <br />(Phone) <br />� t L. nth rm % <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />pint R <br />t <br />/out <br />In signing this application, I hereby acknowledge that I have read and frilly understand the applicable provi_ isions of the Zon• <br />In the application Subdivision O� procedures and and it wlrnini trativa prnoadurca. / further a„k,Iuwledye the ree explanation as outlined <br />Lion expend agree to pay all statements received frarn the City pertain rag Co additional appliDa• <br />r <br />+)N I'rF_orPOa CgyrAFir- ,(.us[n mqr <br />(Signature of Applicant) • <br />PINK —i910 COLD— Pk /nner <br />(Date)�_ <br />of <br />