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CI'`Y OF MOUNDS VIEW <br /> Pr.. ''iNIN ?L:C�1."2;?i <br /> • APPLICANT: La y-r, •i. ,sr�h 4 s Phone 7`U' I :1 1., +- <br /> ADDRESS: .:.9c CI11-4cv1 LI . Ca t.+`rcis I-;ii,�w ,1i 1 ii • S 11 ;l <br /> Street Address, City, State, and Zip Code <br /> Interest in Property (check appropriate box): <br /> Owner of Property <br /> C Contract for Deed Owner <br /> C Lessee, Operator, Manager <br /> C Agreement to Purchase "" <br /> C Other (explain) <br /> Documentary evidence of applicant's interest in the property may be required before final City action of this request. <br /> PROPERTY INVOLVED: <br /> Address/General Location Sc-0-..e — <br /> Legal Description cr Property Identification Number <br /> Legal Owner: Name/Address saw, -- _ <br /> Present Use (check appropriate box): <br /> 77 UndevelapedNacant <br /> • . <br /> 17-7-- Single Family Dwelling ' <br /> `! Duplex/Two Family Dwelling <br /> C Multi-Family (No. of Units <br /> C Business/Commercial Establishment <br /> C Industrial Establishment , <br /> LI Other (explain) <br /> Property Classification: r^ Abstract I—i Torrens <br /> REQUEST: !AriJC;y ,:.., c S U Z O r 7f.t. IC. „,-,0iv u l ✓t C.v. , i,' <br /> l�(.i i. ~ <br /> ,(. ' CC !.'' -. 7'? _'i. i.Z +i C - -. '1 -" (.2,1 . <br /> C. t'�:S ;10 G <br /> :1 :utCd ` <br /> J <br /> • 'Please note: Applicant may be responsible for additional fees asscciatec with the review of this request. <br /> • I HEREBY DECLARE THAT THE ABOVE STATEMENT ARE TRUE. - -(L,-4-41,--- 7//'->'/O <br /> Signature <br /> xxxx*xxx*xxxxxxxx***xxxxxxxxxxxxxxxxx*xx**xxxx xxxx xxxxxxxx xxx x x*xxxx x xxxxxx xx****xx*x*xx*xx* <br /> RR zoning S200/acre.:_minimum $200. maximum 31.000 Park Fund Dedication Fee <br /> {'Variance . R-1 to R-2,...13:D5,575, 1 others S200 _ Date Paid <br /> �cnditional Use Permit R-1 to R-2- ai , ail others 3200 Receipt Number <br /> Code Appeal $75 <br /> Develop.Site Plan Review 51 CO/ac:e, minimum 100, maximum 5500 Total Fees Paid .S'-) -)-- <br /> Minor Subdivision 3150 Date Paid _-i C.,--_ ,;•)/_.' <br /> Maior Subdivision 3250 Pius $250 deposit Receipt Number --6 r,,; 3 1 <br /> 411111 Como. Plan amendment 3200 Fee Alteration Permit 350 plus deposit determined by Starf Additional Fee Paid <br /> Wetland Surfer Permit SI 0 Date =aid <br /> Planning Sign 550 Receipt Number <br /> PUD 3350 <br /> PUC amendment 5150 .r final action <br /> Arr_...NEL :E.':ICS 'A <br /> 8L _ <br /> -,re - i ., -..`-- =!annirp ...ase `1e. "` -.c.r::n. .:cc_..n, `.!e. a <br />