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City of Mounds View,MN <br /> Development Application Page 2 <br /> • <br /> Present Use of Property <br /> ❑ UndevelopedNacant 0 'Single Family Dwelling <br /> ❑ Duplex/Two Family Dwelling 0 Multi-family Dwelling <br /> 174, Business/Commercial Establishment ❑ Industrial Establishment <br /> ❑ Other(explain) <br /> Property Classification 0 Abstract ❑ <br /> Torrens — - - - <br /> Description of Proposal A-t,% E S Ck�S1 i,,� t3LA�16t <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 <br /> Name of Applicant(typed/printed) pJrh�l( _ <br /> =L L V. <br /> Signature of Property Owner <br /> Name of Property Owner(typed/printed) 0010..J <br /> Address of Owner <br /> - L�vc� s?._-._ t3c.�� 55144 k <br /> Phone Number of Owner w )1'it 7556 . 7T) 22) (C <br /> ************************************************************************************************ <br /> FOR OFFICE USE ONLY <br /> Date of Submittal -17 - <br /> Date of Acceptance Assigned to: <br /> Planning Case No. Sa �— a�{, 60-day Limit l20-day limit <br /> Fees Paid: • Account# Check# Receipt# <br /> Application: i. 6. 60 n/e 3 g 6A r' S8 Y-Uft- <br /> Park Dedication: <br /> Deposits: <br /> Other: <br /> Total: <br /> • <br /> N:\DATA\GROUPS\COMDE V\FORMS\DE VAPP.FOR <br /> 1/98 <br />