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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 <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 /> rc.« - tkMo�LeR u�]C <br /> Name of Applicant(typed/printed) � � <br /> �SignatureofProperty Owner . <br /> ... 4 r- . <br /> Name of Owner(typed/printed) f <br /> ,.. f PropertyAcc:�.� am .1) <br /> Address of Owner _ .. <br /> Phone Number of Owner .11)D <CIA t'S" <br /> ************************************************************************************************ <br /> FOR OFFICE USE ONLY <br /> Date of Submittal <br /> Date of Acceptance Assigned to: <br /> Planning Case No. – ciE6 60-day Limit I20-day limit <br /> Fees Paid: Account# . Check# Receipt# <br /> Application: 1 S'- © i. S-7(t(r C,- <br /> Park Dedication: <br /> Deposits: <br /> Other: <br /> Total: <br /> N:\DATA\GROUPS\COMDEV WORMSADEVAPP.FOR 1/98 <br />