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CITY OF MOUNDS VIEW <br /> PLANNING APPLICATION <br /> Date - /o- y/. <br /> APPLICANT: Name /Y dR� F#'UIs '7�S_�'rs`/ <br /> Phone <br /> Address /L(7 �/t ff -MMM( Ali V Piga( t 5f/2— <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 inthe property may be required <br /> before final City action on this request. <br /> PROPERTY: Address/General Location I/etc::/As )/i free) _-2/1/9 PAo 1�RAi9it ll� i l�Rk( /7#'- 3SJ/z <br /> (� / <br /> Legal Owner: Name/Address Ati !/E,vrs5r1 fF AciciRrsc <br /> Present Use (Check Appropriate Blank) : <br /> Undevel oped/Vacant Apartment <br /> Singl e Family Dwell iny /Business Esabl ishment <br /> Dupl ex Dwell iny Industrial Establ ishment <br /> Multiple Dwell iny (3-6 units) <br /> Other (expl ain) <br /> Property Classification: Abstract Torrens <br /> REQUEST: (Expl ain) &ifS� f7 � h� D s�q4/ fd'/I1 yzl �d <br /> l <br /> I hereby declare that the above statements are true. ,1 4 �� <br /> signature) <br />:OR OFFICE USE ONLY: <br /> TOTAL BASE *(Base Fees are Non-Refundabl e) <br /> DEPOSIT FEES <br /> Subdivision , Major $250 ($150) TOTAL FEES PAID Q6"-M - <br /> Subdivision , Minor $100 ($75) Date Paid -/o.- <br /> Rezoning _$100 ($50) Receipt Number .36-801,5Conditional Use $100 ($50) <br /> Variance $75 ($50) 9�--6d <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 /> . <br /> TJ �� _1 <br />