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1 <br /> CITY OF-MOUNDSVIEW <br /> PLANNING APPLICATION <br /> Date 3/ 3A 4 <br /> APPLICANT: Name At'� ��CQ cJ1. — ‘---:-_.. :Phone- 6 -ag437 <br /> Address ltd OC,o" `L� - , Y <br /> Interest in Property (Check Appropriate Bl ank) rr <br /> 7C Owner of RecordLessee, Operator, ,Manayer <br /> Contractor for Deed Owner Ayreement to Purchase <br /> Other (Explain) <br /> } - <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 =- 2� wo0( _ <br /> Leyal_ Owner: Name/AddressaliA,t4-Q L c )O Q� <br /> Rags i ,m. i,00. 0_ <br /> Present Use (Check Appropriate Blank) : <br /> Undevel ped/Vacant `• -'Apartment - -,--i-•'-';.., <br /> . -,_--,::-.- -, - - , . • <br /> e Family Dwell i ng _ Business Esbl ishment <br /> Dup1 ex Dwell my Industrial Establ ishment ` <br /> Multiple Dwell my '(3-6 units) _' ; <br /> - Other (expl ai n) - <br /> Property Classification .Abstract Torrensl <br /> REQUEST (Explain) 1d - A cr-v � SA x.. ` <br /> I hereby decl are that the above statements are true. �ir� , . /,-1, .. ..,.,,,,,4 ,.4-7_, { <br /> iynatur <br /> (s - < - <br /> FOR OFFICE USE ONLY: <br /> _ ,TOTAL ; 'BASE *(Base Fees are Non Refundable) t <br /> :DEPOSIT FEES <br /> N y <br /> x; L Y � Y <br /> Subdivision, Major` $250 ;:($150) . TOTAL EES PAID --,3_j� Q <br />:---. - subdivision , Minor $100 ($75) `:id0•o6 .::,iT!-::- Date Paid. '` s.} -,0o•oo <br /> Rezoning $100 Receipt Number �;; , 7 0�9 <br /> Conditional 'Use =$100 ($J0) }. g _ <br /> Variance $75 • ($50) �r 3 t } <br /> Code Appeal $100 ($50) Park ,Fund�Dedicat ion r <br /> Alteration Permit <br /> �'`$150 ($50) - `Date .Paid <br /> Plan Review $100 ($50) Receipt Number - } <br /> ($50); <br /> Other : _ _ t <br /> PLANNING SIGN $ 50 Addt'l -_Fees'Paid ' <br /> Date Paid i --;• - - i <br /> Receipt .Number -- <br /> l 34- �-. �: <br />