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Little Canada, Minnesota <br />APPLICATION FORM <br />N9 // '795 <br />PAID 1-/a0 <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />Other Planned Unit Development <br />f <br />Plan Review <br />II9D—I 6. i(g tt- 493-1( -� <br />Applicant t e�ry ��r <br />(Name) <br />Owner �Cl- as &KONG <br />(Name) <br />(Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />(0u -wash ova e, r tleei <br />(Address) (Phone) <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 />WHITE— Office CANARY— Customer PINK —File GOLD— <br />Page 15 ( D e <br />) <br />e ro <br />