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CITY OF MOUNDS VIEW <br /> PLANNING APPLICATION <br /> Date :--3/1 -3A) <br /> APPLICANT: Name -rt -L,t l:c C: CCI;; 0 (1 _ C.� 7 {Q' Phone 7 , - 2(1/1 <br /> Address C>..c f\j�-tu-vi (,C(-(_C „-, . <br /> Interest in Property (Check Appropriate Blank) : <br /> ;x' Owner of Record Lessee, Operator, Manayer <br /> — <br /> Contractor for Deed Owner Ayreement to Purchase <br /> — <br /> Other (Expl ain) <br /> Documentary evidence of appl icant' s interest in the property may be required <br /> before final City action on this request. <br /> PROPERTY : Address/General Location .2 J K k i,occ,cL 0,-, _ <br /> Leyal Owner: Name/Address l.(;l,Uo- kt,L,6.(1cV-1 CCG--) <br /> R et 1 cJ,,,i,,_e(i,c r c•'_ 701 <br /> Present Use (Check Appropriate Blank) : <br /> Undeveloped/VacantApartment <br /> e Family Dwell i ny - Business Esabl ishment <br /> Dupl ex Dwell my - Industrial Establ ishment <br /> Multiple Dwell my (3-6 units) <br /> Other (explain) <br /> - <br /> Property Classification: Abstract correns <br /> -- _- <br /> REQUEST: <br /> RE UEST: (Explain) . ,CLu I-Lc ti, (t <br /> `0 <br /> ' <br /> I hereby decl are that the above statements are true. �1 ,, d _ ,i , <br /> '(siynatur- <br /> FOR OFFICE USE ONLY: <br /> TOTAL BASE *(Base Fees are Non-Refundabl e) <br /> DEPOSIT FEES <br /> Subdivision , Major $250 ($150) TOTAL FEES PAID ,3_/ .(--Qa. <br /> Subdivision , Minor $100 ($75) /do-o6 Date Paid , 00• oo <br /> Rezoniny $100 ($50) Receipt Number S 7, c79 <br /> onditndiinnal Use —-_ -----$100- —($504 <br /> Variance $75 ($50) <br /> Code Appeal $100 ($50) Park Fund Dedication <br /> Alteration Permit $150 ($50) Date Paid <br /> Plan Review $100 ($50) Receipt Number <br /> Other ($50) <br /> PLANNING SIGN $ 50 Addt'l Fees Paid <br /> Date Paid <br /> Receipt Number <br />