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Applicant <br />Owner <br />Little Canada, Minnesota <br />APPLICATION FORM <br />Comprehensive Plan Amendment <br />Zoning District Amendment <br />Text Amendment <br />Other <br />N? 478 <br />PAID -7 <br />NWCP- <br />Rec No Z-27- 21 <br />__ Conditional Use Permit <br />Variance <br />Subdivision <br />Planned Unit Development <br />Plan Review <br />Y(>g Kft-)-J LT D, /roc. I C,y(> d.j, vcrIrTY AVE, <br />5T'(A vc-i , ,1, <br />(Name) <br />g - CCNIC Vi t4-2C---90\17 FSZ 1-56 0 <br />(Address) (Phone) . 1,4 -9ocy <br />4tuf)t 3c/2t vi4Jp <br />(Name) <br />Property Location (Street Address and Legal Description): <br />3�4z0 <br />(Address) <br />50.60 Gfn.} LUILCE (c'. i D <br />GE7vTt2k1ILLC <br />(Phone) 452- 75b <br />Description and /or Reason for Request (Cite Ordinance Sections): <br />PL 4,0 gev t -e-J art /J-ez-.) <br />4-DPI T/ 0,4 <br />c.v.P. r,a bc)-F5 tDe 5 T1>. -74 -- of 5671/2 ic, 62.5 <br />In signing this application, I hereby acknowledge that I have read and fully understand the applicable provisions of th <br />ing and Subdivision Ordinances and current administrative procedures. I further acknowledge the fee explanation as r <br />in the application procedures and hereby agree to pay all statements received from the City pertaining to additional <br />tion expense. <br />Page 18 <br />(Sig <br />WHITE — Office CANARY— Customer PINK —File GOLD— Plann& <br />pplicant) <br />r_2 -77 <br />(Date) <br />