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t <br /> CITY OF MOUNDS VIEW <br /> PLANNING APPLICATION <br /> Date 1- -9L . <br /> APPLICANT: Name 6e0fe Co E' tee;aaAi ,� Phone <br /> Address a/ '9 P„rP Gefooc 04. <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 '7G 6c t ,oJ/it4vl/ ,Z . <br /> Legal Owner: Name/Address S AM e <br /> Present Use (Check Appropriate Blank) : <br /> Undevel oped/Vacant Apartment <br /> Si nyl 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) �/1�;¢,1/ee /4/ A-11, '( 1iYc/mseyri2e <br /> I hereby declare that the above statements are true. 6 GT/ <br /> �� 'ynature) <br /> FOR OFFICE USE ONLY: <br /> TOTAL BASE *(Base Fees are Non-Refundabl e) <br /> DEPOSIT FEES <br /> Subdivision , Mayor $250 ($150) TOTAL FEES PAID <br /> Subdivision , Minor 0 ($75) Date Paid <br /> :Cr !nai <br /> $75 ($5 <br /> Code Appeal $100 ($50) Park Fund Dedication <br /> Alteration Permit $150 ($50) Date Paid • <br /> \\\ <br /> Plan Review $100 ($50) Receipt Number <br /> Other ($50) <br /> PLANNING SIGN $ 50 Addt'l Fees Paid <br /> Date Paid <br /> 3/{Co-4a- `-' Receipt Number <br /> a- <br />