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City of Mounds View,MN <br /> Page 2 <br /> Development Application <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 0 Torrens <br /> Description of Proposal <br /> BY MY(OUR)SIGNATURE ON THIS APPLICATION,I HEREBY DECLARE THAT,TO THE BEST OF MY <br /> KNOWLEDGE,THE INFORMATION PROVIDED IS TR AND ACCURATE. <br /> • <br /> Signature of Applicant y _ i <br /> cs <br /> Name of Applicant(typed/printed) /� Off/ ' `~' of l CDC': <br /> Signature of Property Owner ; ;' _ <br /> Name of Property Owner(typed/printed) f L�� f l!5: 7 V <br /> Address of Owner / 9Z-T ` LO/Z (4, <br /> fipQ <br /> Phone Number of Owner 6/2 2 9' ��o/ <br /> ************************************************************************************************ <br /> FOR OFFICE USE ONLY <br /> Date of Submittal /J/Y/9`I ��n� �c��}zl <br /> Date of Acceptance . /OA4/ �7 Assigned to: <br /> Planning Case No. 5-7 •q 60-day Limit 120-day limit <br /> Fees Paid: Account# Check# Receipt <br /> Application: a 5''Oo LO-3L2/0 oto r-I 3[Q <br /> Park Dedication: <br /> Deposits: <br /> Other: <br /> Total: <br /> t/98 <br /> N:\DATA\GROUPS\COMDEV\FORN1S\DEVAPP.FOR <br />