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Present Use of Propertyf"-'-- <br />Property Classification ❑ Abstract <br />❑ Torrens <br />Description of Proposal (attach additional supporting documentation if necessary) <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) <br />Signature of Applicant <br />Name of Property Owner (typed/printed) F (N t t -r2, J" ( Ui jj j A N1 <br />Signature of Property Owner — <br />Address of Owner G � ; z� - NJ id 1�/L I l'o; �'� c> n') A <br />Phone Number of Owner C� /2'- `? >t `: ' ' - > / <br />E-mail of Owner J ' / )t/.� ✓ i}�t_Ji <br />— <br />FOR OFFICE USF ONLY; <br />Date of Submittal i I Ito - I aj Date of Acceptance: I - 1 I 1 `i <br />60 -day Limit v 1 („ 120 -day limit: <br />Planning Case No(s) _"Z C- i 1701_— Assigned to: C _'+C su <br />Fees Paid: <br />Application: <br />Park Dedication: <br />Deposits: <br />Other: _—_— <br />Total: <br />Account # Checic/Credit # Receipt # <br />Page 2 of 2 <br />