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• <br /> CITY OF MOUNDS VIEW <br /> PLANNING <br /> I 'APPLICATION <br /> • <br /> APPLICANT: A,v\--9,noYk L p oY1 K0 ID Phone --N1 -2039' <br /> _ <br /> ADDRESS: 3(O 1 Sin 1 150- 6 Ir\/ ' <br /> Street Address, City, State, and Zip Code - `-' _- <br /> Interest in Property (check appropriate box): <br /> a Owner of Property <br /> ❑ Contract for Deed Owner <br /> ❑ Lessee, Operator, Manager <br /> ❑ Agreement to Purchase <br /> ❑ Other (explain) <br /> Documentary evidence of applicant's interest in the property may be required before final City action of this request <br /> PROPERTY INVOLVED: <br /> Address/General Location .2-9 o cisl YL 32\!'J A V`, <br /> v(o--Bo - .- - a - osLI- <br /> Legal Description or Property Identification Number <br /> Legal Owner: Name/Address A tom, AAA %Yrn`<o Vr>,\') -d C )a,r�a,r q cr,12a <br /> I <br /> Present Use (check appropriate box): <br /> 2---- UndevelopedNacant <br /> III ❑ <br /> ❑ Single Family Dwelling <br /> Duplex/Two Family Dwelling <br /> O Multi-Family (No. of Units ) <br /> ❑ Business/Commercial Establishment <br /> O Industrial Establishment <br /> ❑ Other (explain) <br /> Property Classification: ❑ Abstract 0 Torrens <br /> REQUEST: ShGH.,. -• 6 L o .-R--. cm G Guv,a, • o • h •.tiA ' <br /> _ ,r Lit. D _ sA, _ c /a 2 �a <br /> *Please note: Applicant may be responsible for additional fees associated with iie review of this request <br /> 1hGA. <br /> I HEREBY DECLARE THAT THE ABOVE STATEMENT ARE TRUE. / ; , t� 4.4Q <br /> Signature <br /> Rezoning $200/acre,minimum$200,maximum$1,000 Park Fund Dedication Fee <br /> Variance _ R-1 to R-2-$75,all others$200 Date Paid <br /> (Conditional Use Permit's R-1 to R-2-$75,all others$200 Receipt Number <br /> Code Appeal $75 <br /> Develop./Site Plan Review $100/acre,minimum 100,maximum$500 Total Fees Paid i ",:_`,;�.i <C . <br /> Minor Subdivision $150 Date Paid <br /> Major Subdivision $250 plus $250 deposit Receipt Number <br /> Comp. Plan Amendment $200 <br /> 40 Wetland Alteration Permit $50 plus deposit determined by Staff Additional Fee Paid <br /> Wetland Buffer Permit $10 Date Paid <br /> Planning Sign $50 Receipt Number <br /> PUD $350 <br /> PUD Amendment $150 Date of final action <br /> / APPROVED 0 DENIED 0 ) TABLED ❑ <br /> Date H /�`'/ (5 Planning Case No. Q�` Admin.Account No. f l /. t <br />