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Little Canada, Minnesota <br />APPLICATION FORM <br />N9 800 <br />PAID $200.00 <br />Rec. No <br />Comprehensive Plan Amendment Conditional Use Permit <br />Zoning District Amendment Variance <br />Text Amendment Subdivision <br />x Other Concept Review Planned Unit Development <br />Plan Review <br />Applicant Ronald Paimen 1522 Albany Avenue St. Paul, MN 55108 644 -4469 <br />(Name) (Address) (Phone) <br />Owner Ronald Paimen <br />(Name) (Address) (Phone) <br />Property Location (Street Address and Legal Description): <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />Concept Review of Palmen's Overlook Addition (18 lots) <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 />Page 12 <br />WHITE — Office CANARY— Customer PINK —File GOLD— Planner <br />(Date) <br />