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CITY OF MOUNDS VIEW - <br /> :'.,r,a-. . .y J oar <br /> APPLICANT: ---r'1�� C� Q 1t �t,�,c, (', a22;0, J Phone S1 I 24 4 <br /> ill <br /> L, <br /> ADDRESS: 5.00V ' .c � <br /> �O \(1nl c\1N ZOa`\-S M,r' c <br /> Street Address, City, State, and Zip Code <br /> 0 11 <br /> Interest in Property (check appropriate box): C`°'y / : )6 Q, \�1 e, 1 j n Li <br /> -IF Owner of Property 01ij c <br /> Contract for Deed Owner ` dn (L-1. <br /> ❑ Lessee, Operator, Manager 1—A\2,,k_ ._\‘,,,,,,z, U4 <br /> ❑ Agreement to Purchase -- .l�_�4 O <br /> 0 Other (explain) U <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 2 1 5 5 \- k--, Y <br /> Legal Description or Property Identification Number <br /> Legal Owner: Name/Addresswkp Lo 7. i I <br /> Present Use (check appropriate box): <br /> • ❑ UndevelopedNacant <br /> III ❑ <br /> ❑ Single Family Dwelling <br /> Duplex/Two Family Dwelling <br /> ❑ Multi-Family (No. of Units ) <br /> ''' r- <br /> Business/Commercial Establishment <br /> ❑ Industrial Establishment <br /> ❑ Other (explain) <br /> Property Classification: ❑ Abstract ❑ Torrens <br /> t <br /> REQUEST: j PP 3 'ati +Aa,,., ; 3-$3 -'• ,-1-kilo - t ji` . <br /> *Please note: Applicant may be responsible for additional fees associated iwith the review of this request. <br /> / <br /> I HEREBY DECLARE THAT THE ABOVE STATEMENT ARE TR0 �, t <br /> U , d '` <br /> Signature <br /> *le**t.xx*xxlexle*x**ew-se*iw*wle *w***x*xltxrr**x:t:xx****Irxxxxaese***ve ew****:xxxx*x,tx**ww***,t:t**Ot7c**** <br /> Rezoning $200/acre, minimum $200, maximum $1,000 Park Fund Dedication Fee <br /> Variance R-1 to R-2-$75,all others $200 Date Paid <br /> Conditional Use Permit R-1 to R-2-$75,all others$200 Receipt Number <br /> Code Appeal $75 <br /> Develop./Site P!an Review $100/acre, minimum 100,maximum $500 Total Fees Paid /D D • VG <br /> Minor Subdivision $150 Date Paid ro-,9- 07 <br /> Major Subdivision $250 plus $250 deposit Receipt Number 474'Cas'y <br /> • <br /> Comp. Plan Amendment 5200 l <br /> Wetland Alteration Permit $50 plus deposit determined by Staff Additional Fee Paid <br /> Wetland Buffer Permit $10 Date Paid <br /> Planning Sign $50 Receipt Number <br /> PUD $350 <br /> PUD Amendment $150 Date of final action <br /> � APPROVED DENIED i TABLED Q <br /> Date 1 L.'.' s <br /> '• 1 Planning Case No. /�� " `"n L c4 Admin.Account No. <br />