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City of Mounds View,MN <br /> Development Application Page 2 <br /> Present Use of Property <br /> .' Undeveloped/Vacant o Single Family Dwelling <br /> Duplex/fwo Family Dwelling o Multi-family Dwelling <br /> Business/Commercial Establishment o Industrial Establishment <br /> C Other(explain) <br /> Property Classification o Abstract Torrens <br /> Description of Proposal Co ets•i-ruC+t v1 or a ''- - 0(14 Al z keim2r'S Cacti y <br /> lZezorte fLetoesl- : 12- 'j, t-I De_rtsJ IZes,tp,.,Aizt. <br /> C erLdc 4-co.4.2tl UseR��1 4. : Se64-ie.t ttoct. 0145.6d. 2_ <br /> " Nurs�Aft 1-loM.ec 'iRd St4,tar- Group l-toc. tn . - " <br /> BY MY(OUR)SIGNATURE ON THIS APPLICATION,I HEREBY DECLARE THAT,TO THE BEST OF MY <br /> KNOWLEDGE,THE INFORMATION PROVIDED IS TRWAND ACCURATE. <br /> 4///mSignature of Applicant <br /> Name of Applicant(typed/printed) M <br /> Signaturei L e �i piK e R•� • <br /> of Pro / <br /> party Owner i1iL� l <br /> Name of PropertyOwner(typed/printed) <br /> "REAL,-., C . <br /> . <br /> Address of Owner S.2 3 S ou-r.t 8-n.j S1-1t.E E-r <br /> MINrJCAPo t.ts MAI ss'ln4_ ( csI S <br /> Phone Number of Owner (4 it) S o S - 2 c 2.1 <br /> A r+4 : t3Ruc.t 4.t• EntGELS/y, <br /> ■**************rip*********+k****+R*******************F************* m ******fr******.** <br /> FOR OFFICE USE ONLY <br /> Date of Submittal <br /> Date of Acceptance Assigned to: <br /> Planning Case No. e5 60-day Limit 120-day limit <br /> �L O- f vl <br /> Fees Paid: Account# Check# I Receipt it <br /> Application. 19 .00 //-:3Liae )10-A9.---)9 <br /> Park Dedication: <br /> Deposits: <br /> Other: <br /> Total: <br /> N:IDATAZROUPS\COMDEVNFORMS\DEVAPP.FOR 1/95 <br />