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Applilic-a ion fees zarre inion- of unda bgle. <br />Present {LUSS.` VA ProperL ��-'�� r 1' i l � 1i��r:� ----- Lift � <br />PropertyCibssficationa ❑ Abstiact lK Torrens <br />Descirip- ion of Pr oposai (attach additional supporting documentation if necessary) W <br />�7�� � ` C � T _•e=� r c..:. !' L i i G f t '- F�`�- � L t - OC • �. ! �.1 =' t -C c-.' �. <br />-- <br />-� <br />0 i o <br />CA.! I <br />Y MY/OUR SIGNATURE ON THIS APP�ICON, I HEREBY DECLAP PE. THAT, TO THE <br />BEST OF MY KNOWLEDGE, THE INFORMATION PROVIDED IS TRUE AND ACCURAI tt. <br />Please PAo'te: Application fees are nonrefundable. Applicant's 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 Vievd. 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 <br />Signature of Applic. <br />Name of Property Owner (typed/printed) <br />Signature of Propeity Owner <br />Address of Ovnn�r <br />Phone Number of Owner a`! = '� 2!, <br />E-mail of Owner 'LL; i%i.^ ,..,r4_•C; CZ -r_ <br />Date of Submittal! j ? _ ? / f z" Date of Acceptance; <br />6.o -day Emile 120 -day limit: <br />Planning Case No(s) _l h-- /' C t=' ! Assigned to: <br />Fees Paid: Account i 'h ck[Ogedit # Re i�it•#F _ <br />Application: _,1 % ?L?l <br />1?ark Dedication: .^ _ ---- ----- <br />Other: <br />Total: --- — <br />Page 2 of -2 <br />