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City of Mounds View, MI <br />Develo meet A lication <br />Pa e2 <br />Present Use of Property <br />O Undeveloped/Vacant Single Family Dwelling <br />O Duplex/Two Family Dwelling ❑ Multi- family Dwelling <br />• Business/Commercial Establishment ❑ Industrial Establishment <br />• Other (explain) <br />Property Classification 0 Abstract <br />Description of Proposal <br />❑ Ton-ens <br />.. .._. . -.. - r::•.:•�.,�i- :5..1i: :.'i +'ji <br />BY MY (OUR) SIGNATUREE ON THIS APPLICATION, I HEREBY DECLARE THAT, TO THE BEST OF MY' <br />KNOWLEDGE, THE INFORMATION PROVIDED IS TRUE AND ACCURATE. <br />Signature of Applicant <br />Name of Applicant (typed/printed)Q,r,� <br />Signature ofProperty Owner <br />Name of Property Owner (typed/ anted <br />Address of Owner _�1�5sr�t �ra` <br />Phone Number of Owner ( �' <br />uw <br />r,n _ <br />': •6 Z . 'i lot fi.:a�... F::+YsrdE,� tl-n >L�i .F..s -_ <br />*** * * ** * *** *gyp * * ** ** * ** *** ****M** * * * *>rsM** **** ** ** ** * * * * * ** ** ** * *o!>M ****** *** * ** oR*** *** * * ** * **oF>p *** <br />Date of Submittal <br />Date of Acceptance <br />Planning Case No. <br />FOR OFFICE USE ONLY <br />7 -10 - <br />Fees Paid :.. <br />Application: A 75 - <br />Park Dedication: <br />Deposits: <br />Other. <br />Total: <br />NAD ATA IGROUPSICOMDEVIFOR NiSZEVAPP.FOR <br />53( -8L g <br />60-dav Limit <br />• :. Account <br />Assigner to: <br />I20 -day limit <br />Check # • : - Receipt # <br />973 9 339 <br />• <br />1198 <br />