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CITY <br /> �tOOF <br /> MOUNDS VIEW <br /> ..� NN <br /> �.s 7?-1- <br /> APPLICANT: • /2 t'e Cly Phone 7,580 xJ/3 <br /> ADDRESS: . y/ / C��,� ,0&,./ /`�- �` j/ '�'�;/7//1 ,57s7/ <br /> Street Address, City, State, and Zip Code <br /> Interest in Property (check appropriate box): <br /> ;Et Owner of Property <br /> ❑ Contract for Deed Owner <br /> ❑ Lessee, Operator, Manager <br /> O Agreement to Purchase "a <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 A. vz c,c/c/ <br /> Legal Description or Property Identification Number G c;• j 3 <br /> Legal Owner: Name/Address 4,1-h 4. -e-- <br /> Present <br /> e—Present Use (check appropriate box): <br /> ❑ UndevelopedNacant <br /> Single Family Dwelling <br /> ❑ Duplex/Two Family Dwelling <br /> ❑ Multi-Family (No. of Units <br /> ❑ Business/Commercial Establishment <br /> ❑ Industrial Establishment <br /> ❑ Other (explain) <br /> Property Classification: ❑ Abstract ❑ Torrens <br /> REQUEST: X /7 G Liew e_ /a/ e/4- A ,s -5/ <br /> �i <br /> ,�fr Cir.it--�r-o L�/��/moi e Tv Gait `v vt - <br /> 1✓�7!^ s'6t l //S(�e'd, d 5 'c.c y Gt-- (7 2,e k- r'. f•2 '1'- <br /> *Please note: Applicant may1e responsible for additional fees associated with the review of this request. <br /> I HEREBY DECLARE THAT THE ABOVE STATEMENT ARE TRUE. <br /> Signature <br /> ******************************************************************************************** <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 j//3/94/ <br /> Conditional Use Permit R-1 to R-2-S75,all others$200 Receipt Number <br /> Code Appeal $75 <br /> Develop./Site Plan Review $100/acre, minimum 100, maximum $500 Total Fees Paid OV <br /> Minor Subdivision $150 Date Paid FEZ15/ <br /> Major Subdivision $250 plus $250 deposit Receipt Number <br /> Comp. Plan Amendment $200 • <br /> 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 /> q 'jAAPPROVED 0 DENIED ❑ TABLED 0 <br /> Date Planning Case No. 3nj �- i Admin. Account No. <br />