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City oiMounds View, MN <br />Develo ment A lication <br />Present Use of Properiy <br />� Undeveloped/Vacant ,,.e� Single Family Dwelling <br />� Duplex/Two Family Dwelling � <br />� Business/Commercial Establishment � Multi-family Dwelling <br />� Other (explain) . �ndustrial Establishment <br />Property Class�cation . ❑ <br />Description of Proposal <br />Abstract <br />� <br />Toirens <br />Ya�e 2 <br />BY MY (OUR) SIGNATURE pN THIS ppp�,j�ATTON, I HEREBy DECLARE THA.T, TO THE BEST OF MY <br />, KNOWLEI7GE, TI� INFpRMqTION PROVIDED IS TRUE AND ACCURATE. <br />. Signature ofApplicai�t : _ . � <br />I, ��-ke,c.�� . <br />Name of Applicant (typed/printed) . 7"7` ,,� i2 R�,. Y- .. <br />_ M 121�J��ve M-�tn/�2T` <br />Signature ofProperty Owner � ' - � <br />� _ Name of Property Owrier (typed/printed) - <br />. ' �e' ' �- /�'��YiZ y J .i/ � M e � �/��e % <br />Address of Owner :i�.I % S�i,1/ .? cr� v U�� " <br />. � � %Z l� B K.�,'„�f l/i,��� <br />� �1�J• 5 S�.i2 `7L>.3- %JG-I� �G� <br />� Phone Number of Owner � � <br />� . . .. <br />*********�***�************�*****�*************************************************************�x* <br />Date of Subinittal . FOR OF�'ICE USE O1VLy �� <br />Date of Acceptance � a � � � . �; . <br />Planning Case No. �^ L Assigned to: �_ <br />60-day Limit 120-day limit <br />-----� <br />' Fees Paid: � <br />Application: ' %,�,� <br />Park Dedication: <br />Deposits: . <br />Other: . <br />Total: <br />h1:�DATAIGROUPSICOMDEV\i'ORMSIDEVAPP. FOR <br />Account # Check # Receipt # <br />� ^�n y (� �L / �' I S�5 �' <br />1/98 <br />