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City of Mounds View, MN <br />Development Application Page 2 <br />Present Use of Property <br />❑ Undeveloped/Vacant � Single Family Dwelling <br />❑ DuplexlTwo Family Dwelling ❑ Multi-family Dwelling <br />❑ Business/Commercial Establishment ❑ Industrial Establishment <br />❑ : Other (explain) <br />Property Class�cation ❑ Abstract � Torrens ' <br />Description of Proposal (�t� a-} S i f-�c.� i �'P�i/� S i O,�� � S Ff L� <br />i�>������ ,, t�� �-,�P;�rt � <br />BY MY (OUR) SIGNATURE ON THIS APPLICATTON, I HEREBY DECLARE THfIT, TO TI-� BEST OF MY <br />KNOWLEDGE, TI� INFORMATION PROVIDED IS E A A <br />Signature of Applicant � <br />Name of Applicant (typed/printed) I�C� (`3� R`J .'j .. K L L i�� Cl� � I�r <br />Signature of Property Owner <br />Name of Property Owner (typed/printed) <br />Address of Owner <br />S�-M � (� s f� t�� L l f r ri <br />Phone Number ofOwner � . . <br />****+******************************************************************************************* <br />� FOR OFFICE USE ONLY . - <br />Date of Submittal a��- �- a�jp ' <br />Date of Acceptance Assigned to: <br />Plaruinig Case No. s u e�- O o a� 60-day Limit 120-day limit <br />Fees Paid: Account # � Check # Receipt # � <br />Application: -�.� ' � 1 D D.-.3 � '7 � (,P d � �( . - .. �fS'9 / <br />Park Dedication: � � � � <br />Deposits: <br />Other: <br />Total: � <br />N:�DATA\GROUPSICOMD�V�FORMS\DEVAPP.FOR 1/98 <br />