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AppflccaCr an fees are non-refundable. <br />Present Use of Property C o � � nn r' l y (f h , GA <br />Property Classification ❑ Abstract ©� Torrens <br />Description of Proposal (attach additional supporting documentation If necessary) <br />Linu Ll 1.4t %+ Pe Al—" _'_- eun.....i. l:.,n ...:aa. n-/..__.�.. .✓.'r l�.. <br />"e if s4 1- yu ft ire a>/pP & 04, eoo s, <br />BY MY/OUR SIGNATURE ON THIS APPLICATION, I HEREBY DECLARE THAT, TO THE <br />BEST OF MY KNOWLEDGE, THE INFORMATION PROVIDED IS TRUE AND ACCURATE. <br />Please Note; Application fees are nonrefundable, Applicants are responsible for all <br />costs in excess of the application fee incurred by the City in the processing of this <br />application. Such excess fees are to be paid upon receipt of statement from the City of <br />Mounds View. Excess fees may include, but shall not be limited to, photocopy costs, <br />staff time, and fees for planning consultants, attorneys and engineers. In some cases, a <br />deposit may be required in advance to cover any anticipated excess costs associated <br />with this application. (If a deposit is required, the applicant shall remain responsible for <br />all reasonable incurred costs in excess of the application fee and deposit amount.) <br />I ACKNOWLEDGE THAT I have read all of the information listed in the Planning <br />Application and fully understand that I am responsible for all costs incurred by the City <br />related to the processing of this application. <br />Name of Applicant (typed/printed) /(N/�^ 4 /\ to tom; 01< <br />Signature of Applicant 40,C__ .G <br />Name of Property Owner (typed/printed) <br />Signature of Property Owner <br />Address of Owner <br />Phone Number of Owner '76 3 - -7S'V ^ i ') JT <br />E-mail of Owner e ev kk+j- cdrnsn , co.j <br />rva vrraa.c we UNLi: <br />Date of Submittal <br />60 -day Limit <br />Planning Case No(s) <br />Fees Paid: <br />Application: <br />Park Dedication: <br />Deposits: <br />Other: <br />Total: <br />Date of Acceptance: <br />120 -day limit: <br />Assigned to: <br />Account # Check/Credit # Receipt # <br />Page 2 of 2 <br />