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COMMUNXTY DEVEL®PMEMY DEPARTMENT, <br />- PLANG ZNG APPLICAT90N <br />2401 County Road 10, Mounds View, MN 55112 <br />(763) 717-4O20 * Pax (763) 717-4019 <br />permits@cLmounds-wiew.mmis <br />Please Type or Print Information - Complete Both Sides of This Form <br />Applicant Information ( <br />Name of Applicant %L2 ( t mu P, PLA 1 N �U nzrix N 5 Work # 1 x'11- <br />Address a 11� (_ ,n; ti r u2.4 % City. - State � iJ Zip X117 <br />Home # 2. dj� 6 Cell # 61 QL) ';'A `i 22; Fax # <br />E-mail ' I�u � � A-, r,, c0 4-4c 1 Al Q'� �' COM <br />Interest in Property (check appropriate box) <br />1%116 wrier of Property ❑ Contract for Deed Owner ❑Lessee, Operator, Manager <br />ElAgreement to Purchase ❑Other <br />Applicants mustprovide evidence ofinterestin properfyatthe time ofapplicadon, andifyou are <br />not the owner of the property, you must either provide a letter of permission from the owner <br />giving consent to the filing of this application orthepropertyownermustsign this application for <br />it to he accepted, <br />Property Description/ Proposal <br />Address or General Location <br />Legal Description f -O} I , 3 1 �cL-f- Z. <br />Property Identification # (PIN #) 34t - 3o --L3 -- 2(_ o04-7 e <br />#of Acres ol 5W CurrentZoning g-( <br />Type of Application (Please check the appropriate boxes), <br />Comprehensive Plan Amendment <br />500 <br />Rezoning <br />$500 <br />Maior Subdivision <br />700 <br />Minor Subdivision <br />350 <br />Planned'Unit Development PUD <br />$750 <br />PUD Amendment <br />400 <br />Conditional Use Permit/Amendment <br />R-1 R-2 200; all others 400 <br />Interim Use Permit/Amendment <br />400 <br />Variance <br />R-1 R-2. 200 all others 400 <br />Administrative Variance <br />R-1 R-2 $100 <br />Text Amendment Zonin `Cade <br />400 <br />Text Amendment Other city Code <br />300 <br />Develop Review/Site Plan Review <br />400 <br />Wetland Alteration Permit <br />I R-1 R-2 $200• all others 350 <br />Wetiand Buffer Permit <br />R -1,R 2 $30° ail others 100 <br />Easement Vacation <br />250 <br />Re -approval of Minor Subdivision or Plat <br />Minor Subd. 50• Plat 100 <br />Zoning Review of B-1 District Proposed Use1$200 <br />Page 1 of 2 <br />