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CITY OF MOUNDS VIEW <br /> PLANNING APPLICATION • <br /> Date ///2 /9/ <br /> APPLICANT: Name //s° / 111 -cS) :Phone 7(1S1")-6 vy <br /> . . Address 7/00u / G r • <br /> Interest in Property (Check Appropriate Blank) : <br /> 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 23'// e9, �c�ood./ `,Ori/cry <br /> Legal Owner: Name/Address <br /> Present Use (Check Appropriate Blank) : <br /> • <br /> Undevel oped/Vacant Apartment <br /> Singl a Famil y Dwell my Business Esabl..ishment. <br /> upl ex;Dwel 1 my Industrial _;Establishment <br /> Mul tipl a Dwell my (3-6 units) - <br /> Other (expl ain) <br /> • <br /> Property Classification:. .. Abstract , Torrens <br />;Ei�UEST �OIJ•G <br /> (Expl ain) � :_ • -_•� <br /> . ./!2.nV-� 7 S �� < libwAj flame s'Grcr _ <br /> hereby declare thatthe above statements are tru <br /> ��' <br /> r signature <br /> OR OFFICE USE ONLY: <br /> TOTAL BASE *(Base Fees are Non-Refundable) <br /> DEPOSIT FEES' <br /> Subdivision ,:Major_ $250 ($150) 3 TOTAL-FEES PAID )50 00 <br /> .Subdivision, _Minor- - $100 ($75) 4 t Date Paid <br /> Rezoning ``$100 _. <br /> :($50) - Receipt'Number <br /> Conditional , •Use ' 100 ••($50) <br /> $ 34S�t7 <br /> Variance • 175 ' s, z • _ 4: ;'' <br /> `Code Appeal • $100 <br /> ($50) Park Fund Dedication <br /> Al teration Permit $150 ($50) - ) So•rb •"Date Paid. <br /> Plan Review z ($50) . Receipt Number. <br /> • Other , • ($50) : <br /> PLANNING SIGN $ 50 Addt'l Fees Paid <br /> t Date Paid n <br /> Receipt Number <br /> aL s n -1 > i• 5�,v+s Kt i Axa t , �. { � <br /> ��1+ � F r x, J - }=`� ~''• <br /> � � $'ir _ 1'`� �� S 1 <br />