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_ City of Mounds View,MN <br /> Development Application Page 2 <br /> Present Use of Property <br /> ❑ Undeveloped/Vacant _ Single Family Dwelling <br /> ❑ Duplex/Two Family Dwelling ❑ Multi-family Dwelling <br /> ❑ Business/Commercial Establishment ❑ Industrial Establishment <br /> ❑ Other(explain) <br /> Property Classification 0 Abstract ❑ Torrens <br /> Description of Proposal (T, $ci t t-D RE-S t bE+JTt+A h uS E- "' L+ L EV <br /> BY MY(OUR)SIGNATURE ON THIS APPLICATION,I HEREBY DECLARE THAT,TO THE BEST OF MY <br /> KNOWLEDGE,THE INFORMATION PROVIDED IS TRUE AND ACCURATE. <br /> �1�Signature of Applicant - �`�•`w�? �-� , a <br /> Name of Applicant(typed/printed) 7�+rvy PA LA i 19 <br /> Signature of Property Owner <br /> Name of Property Owner(typed/printed) B U Ul.• `7 j o tti 6 <br /> Address of Owner 1 I M ft IES t1(z S . <br /> /v) I J .J )N t.'s� N1 J 676-411 3 <br /> Phone Number of Owner t t 2- -7E 2 -2 S-eV 6 451 -L 33 --/ <br /> Z�� <br /> ************************************************************************************************ <br /> FOR OFFICE USE ONLY <br /> Date of Submittal 8-3 - 91 <br /> Date of Acceptance -3 g Assigned to: <br /> dt <br /> Planning Case No. (G(G C Cj, 60-day Limit 120-day limit <br /> Fees Paid: Account# Check# Receipt# <br /> Application: eti-a d 3 Le gO I d 9-5 / <br /> Park Dedication: <br /> Deposits: <br /> Other: <br /> Total: <br /> 1/98 <br /> N:\DATA\GROUPS\COMDEV\FO RMS\DEVAPP.FOR <br />