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., ,, I <br /> CITY OF MOUNDS VIEW <br /> PLANNING APPLICATION 0 <br /> Date// 3� <br /> APPLICANT: Name ,�� Phone <br /> Address 7,6:::0,.....S"---. .. Amp- / � /1 i <br /> Interest in Property (Check Appropriate B1 .nk) : <br /> )C Owner of Record Lessee, Operator, Manager <br /> Contractor for Deed. Owner Agreement to Purchase <br /> Other (Expl ain) <br /> Documentary evidence of applicant' s interest in the property may be required <br /> before final City action on this request. . <br /> PROPERTY : Address/General Location r, w �� <br /> s /7` o <br /> Leyal Owner: Name/Addressr-,-roomy #,.J�-d <br /> Present Use (Check Appropriate B1ank) : <br /> Undevel oped/Vacant Apartment • <br /> Singl a Family Dwell ing Business Esabl ishment <br /> Duplex Dwell ing Industrial Estabi ishment <br /> Multiple Dwell my (3-6 units) <br /> Other (expl ain) /7'(9 <br /> Property Classification: Abstract Torrens <br /> EQUEST: (Expl ain) /_ ! — _ �, ./1, — _ <br /> hereby declare that the above statements are true. <br /> iiKO signature) <br /> DR OFFICE USE ONLY: <br /> TOTAL BASE *(Base Fees are Non-Refundabl e) <br /> DEPOSIT FEES <br /> Subdivision , Major $250 ($150) TOTAL FEES PAID JO *.-.- <br /> Subdivision, <br /> Minor $100 ($75) Date Paid <br /> /7 so <br /> Rezoning $100 <br /> ($50) /00. 00 Receipt Number 6 <br /> Conditional Use $100 ($50) <br /> Variance $75 ($50) <br /> Code Appeal $100 ($50) Park Fund Dedication - III <br /> Alteration Permit $150 ($50) Date Paid <br /> P1 an Review $100 ($50) Receipt Number <br /> Other ($50) <br /> PLANNING SIGN $ 50 Addt'l Fees Paid <br /> J Date Paid <br /> Receipt Number 0rT <br /> 0 <br /> 0 <br />