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CITY OF MOUNDS VIEW <br /> PLANNING APPLICATION • <br /> Date ii- 30-9D <br /> •APPLICANT: Name /,Or (ITU ;,ale t� ?Fee� Phone 819 <br /> (on( „h iecOic b Ro " ( Ae2.�Address <br /> Interest in Property (Check Appropriate Blank) ; <br /> VOwner of Record Lessee, Operator, Manager <br /> Contractor for Deed Owner Agreement to Purchase <br /> Other (Explain) <br /> 'Documentary evidence of applicant' sinterest in the property may be required <br /> .`before final City action on this request ' <br />'ROPERTY Address/General Location (0OJ — CC (- i'\-c--f�(,L1co� i c)M-b - <br /> IN\ <br /> Legal Owner: Name/Address If j j, ' s L c _id' 4 Al gle1PE—,C) <br /> )1 J4r;'Ff'Ci x-f V <br /> Present Use (Check Appropriate Blank <br /> Undevel oped/Vacant Apartment <br /> Singl a Family Dwell my Business Esabl ishment MI <br /> • - <br /> Duplex Dwell my Industrial ``Establ ishment <br /> Multiple Dwell my (3-6 units) <br /> Other (expl ain) <br /> • <br /> Property Classification: Abstract Torrens <br /> EQUEST: (Explain) t p--JQ f3 (---)A)), ioL <br /> /, <br /> hereby decl are that the above statements are true ,/, /. /, <br /> signature <br />)R OFFICE USE ONLY: <br /> TOTAL BASE *(Base Fees are Non-Refundable) <br /> DEPOSIT FEES <br /> Subdivision , Major $250 ($150) A,gO.4O TOTAL FEES PAID ° 'SO °� <br /> Subdivision , Minor $100 ($75) Date Paid /I 3o 0 <br /> Rezoning $100 ($50) Receipt Number . 4/567 <br /> Conditional Use $100 ($50) <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 />