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�.%za:ars 14:46 F.i� 912 784 3313'. CIr OF 003/005 <br /> City of Mounds View,MN <br /> Develo•ment A•oiication <br /> Paee 2 <br /> L,resent Use ofPr+opctry <br /> L'a,develaped/Vaeaat <br /> o <br /> DuplewTwo=aasilyDwel:ing Single Family Dwelling <br /> O BusiaGsslCoauaercial Saab lishmaat IrIuIa trial y Dwelling <br /> C Other(explain) fnstial Establishment <br /> Property Classification )( Abscact C Torrens <br /> Des tion•fProposal gir is;,L._ •LAT" ,� '� U t> I � l.,t�bt 4 <br /> •�_ <br /> • <br /> B Y MY(OUR)SIGNA.TURE ON THIS APPLICAT'ON,I HEREBY DECLARE THAT.TO THE BEST OF MY <br /> KNOWLEDGE.T'-.E INFORMATION?ROI/MED IS TRUE AND ACCURATE. <br /> Signature of Applicant <br /> Name of Applicant(typed/printed). <br /> Signature of Property O - . <br /> Name ofPrope;ty Owner(tvped/priate ) £dFaI iG/ J <br /> � tri -1Z�� / 'is �`. � �/{• ' <br /> Address of Owner , <br /> u trkir rU , <br /> Phone Number of Owner i14- .L4. <br /> 1163- 5Si <br /> *�+.****** ******an•s*. M**s*•+*ws41. **y****Oa*s*y**tey <br /> •Darn ofSul*Siittsl • <br /> FOR OFFICE USE ONLY <br /> Data of Acceptance <br /> AssigPlatmizg Case No. 60.day Limit 20-day <br /> l to: <br /> - t2O-day limit• _ • <br /> • Fees Paid: Acatrat* Ceck ReciptApph # <br /> Park Dedication: <br /> Deposits: <br /> Otho: <br /> Total: <br /> • <br /> MADATACRAUPStiCOb4CC FORK DEVAPl.F0R <br /> 1138 <br />