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City of Mounds View, MN <br />Develo a merit A r lication <br />Page 2 <br />Present Use of Property <br />Undeveloped/Vacant 3 Single Family Dwelling <br />fclvDuplex/Two Family Dwelling O Multi-family Dwelling <br />Business/Commercial Establishment Q Industrial Establishment <br />a Other (explain) <br />Property Classification ❑ Abstract 0 Torrens <br />Description of Proposal <br />BY MY (OUR) SIGNATURE 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) <br />Signature of Property Owner <br />Name of Property Owner (typed/printed) <br />Address of Owner <br />Phone Number of Owner <br />Date of Submittal <br />Date of Acceptance <br />Planning Case No. <br />NU) v <br />Li( —g3 <br />FOR OkkHCE USE ONLY <br />z i5csq _ <br />t2 , G S Assigned to: <br />60 -day Limit t - 10 -144 1 20-day limit 3- 1- <br />Fees Paid: <br />Application: Zcc.) <br />Park Dedication: <br />Deposits: <br />Other: <br />Total: ; <br />Account <br />Check # <br />Receipt <br />4:'. DATA AGROL;PS\COMDEV\ FORMS1DEVAPP.FOR L'9g <br />