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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 /> De ption..o P oposal '( kttret C ,ei9 j l ata 1 find <br /> U cel <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 /> Signature of Applicant - Dcri <br /> cy# <br /> Name of Applicant(typed/printed) Nan Dhr <br /> Signature of Property Owner alt.r. al-c-od <br /> kljall(Ln \- thY/e <br /> Name of Property Owner(typed/printed) P1\an 1 1-cam <br /> i. <br /> Address of Owner 13 Prifil-Lonod ' ``'""-"' <br /> cic rc1 tait.13 1111Q EL 11 <br /> Phone Number of Owner <br /> NODI-ter ca- )a5 }oma <br /> (obi-- 444—(Ar15 Ala is tar <br /> (Dia - 3 —63)-10 `�c�lY`rli t WO rt <br /> ************************************************************************************************ <br /> FOR OFFICE USE ONLY <br /> Date of Submittal 9-t O <br /> Date of Acceptance Assigned to: <br /> Planning Case No. 57 / C3 9' 60-day Limit 120-day limit <br /> Fees Paid: O Account# Check# Receipt# <br /> Application: -7 5 /o0 3a—2 GI 33�1.D <br /> Park Dedication: <br /> Deposits: <br /> Other: <br /> Total: <br /> N:\DATA\GROUPS\COMDEV\FORMS\DEVAPP.FOR 1/98 <br />