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City of Mounds View,MN <br /> Development Application Page 2 <br /> Present Use of Property <br /> a Undeveloped/Vacant X Single Family Dwelling <br /> ❑ Duplex/Two Family Dwelling a Multi-family Dwelling <br /> a Business/Commercial Establishment a Industrial Establishment <br /> a Other(explain) <br /> Property Classification ❑ Abstract ❑ Torrens <br /> Description of Proposal 77- et Qtrt L) , SCh rni-1{ Okirhi ilk O �� I4'11�t to vt) <br /> �q ►1 P 4-bre P iy-6nn r 'r . kit n n Q aej34 tat <br /> kin __!e einem, anti S,np r i n Q. jP r'qn . <br /> BY MY(OUR) SIGNATURE ON THIS APPLICATION I HEREBY DECLARE THAT,TO THE BEST OF MY <br /> KNOWLEDGE,THE INFORMATION PROVIDED I TRUE AND ACCURATE. <br /> Signature of Applicant <br /> Name of Applicant(ty,ped/printed) 7' 1U P..4‘1 kF+y HIL4 _T" <br /> c <br /> Signature of Property Owner / • A I` �y <br /> Name of Property Owner(typed/printed) T ►1,t rid/ W a y .S F h nt i <br /> Address of Owner (sem) (e 1-1 k ke to P t,•a ck <br /> fir u d S \) ) ) S\ \::) L <br /> Phone Number of Owner (c,,,�) La - )% - ; loth.- R --501-1 <br /> FOR OFFICE USE ONLY <br /> Date of Submittal <br /> Date of Acceptance Assigned to: <br /> Planning Case No. 60-day Limit 120-day limit <br /> Fees Paid: Account# Check# Receipt# <br /> Application: <br /> Park Dedication: <br /> Deposits: <br /> Other: <br /> Total: <br /> N:\DATAGROUPSCOMDEVNFORMSDEVAPP.FOR 1198 <br />