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Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />Applicant Pe <br />my <br />(Name) <br />N? / 795 <br />PAID lzd <br />Rec. No <br />Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />N/ <br />Plan Review <br />W . Gt <br />11951 S. e019ery -F L9t 5z (2. t,g(- 460-4 - <br />(Address) (Phone) <br />Owner & as &iXOV6 <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />(Corwask Ov, s eIC?,) <br />as well as two lots immediately north. <br />2600, 2616, and 2620 Rice Street <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />Concept review of development of tire store on this site. <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of the Zon- <br />ing and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as outlined <br />in the application procedures and hereby agree to pay all statements received from the City pertaining to additional applica- <br />tion expense. <br />(: (D e) <br />WHITE— Office CANARY — Customer PINK —File GOLD—Pia", <br />PN aE 9 <br />a is <br />