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' City of Mounds View,MN <br /> Development Application Page 2 <br /> III <br /> Property Classification 3d Abstract a Torr <br /> Description of Proposal 5F e C�---w mdn <br /> BY MY(OUR) SIGNATURE ON THIS APPLICATION,I.I a Y DECLARE THAT,TO THE BEST OF MY <br /> • <br /> • <br /> KNOWLEDGE,THE 11FORMATION PROVIDED IS TR . • u ACCURATE. <br /> Signature of Applicantk 1/.4 <br /> Name of Applicant(Lyped/prnued) 6Aity AftC' <br /> Signanrre of Pr ooer ty Owner 1 i / <br /> Name of Propm-ty Owner(typed/atinted) �1 G h 1 111 <br /> ,4 S 6v r?P. <br /> • <br /> s <br /> FOR OFFICE USE ONLY <br /> Date of Submittal .3, 4c) yct -i <br /> Date of acct canoe J s,.t ?S- t C c, 7 <br /> -•`1 I Assigned to: ,•• <br /> Pla g Case Vo. Coo- Q?7 60-day Limit 4 -23-y 7 120-day Limit ( t-22 -5 7 <br /> Few Paid: Accu t C'.aecic <br /> Application: 1r ,o .7 `f.5-5 _,--6,r o1O <br /> ?irk Dedication: <br /> sits: <br /> qp <br /> : <br /> Total: <br /> C.`.OFF?CZWFWENtiWPDOCSIAD ` .FORMSIDEVAPRAOR ;,4 <br />