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CITY OF MOUNDS VIEW <br /> PLANNING APPLICATION <br /> APPLICANT: K;.r k O15o - Mertk.,v i)/e Oar M Mw + I Phone <br /> ADDRESS: &{7s-c3 S4. S, vev(,, /11A) WSJ 90 <br /> Street Address, City, State, and Zip Code <br /> Interest in Property..(check appropriate box): <br /> ❑ Owner of Property <br /> ❑ Contract for Deed Owner <br /> • <br /> Lessee, Operator, Manager <br /> ❑ Agreement to Purchase <br /> ❑ Other (explain) <br /> Documentary evidence of applicant's interest in the property may be required before final all/action of this request • <br /> PROPERTY INVOLVED: <br /> Address/General Location U.S, E� )(O Cam n-� R:0- L C,�,,�, �, �Q <br /> 1 '7ct,,,,cis V )e k.) ("1 t- -- 1\1.-t Y dsu;e-td.) i.(a de 1,10P4,in �01A r <br /> Legal Description or Property Identification Number 073x-�3/J6079 -3 <br /> Legal Owner: Name/Address {KGs-1-er &,-(e,rac>se; <br /> -7 Cini. /er5 -t/t, {fie S+_ PA.1 c3 I1 -11,7"7 <br /> Present Use (check appropriate box): <br /> ❑ Undeveloped/Vacant <br /> O Single Family Dwelling <br /> ❑ Duplex/Two Family Dwelling • _ <br /> Multi-Family (No. of Units ) <br /> etSc Business/Commercial Establishment <br /> • <br /> ❑ Industrial Establishment <br /> ❑ Other (explain) <br /> Property Cassification: 0 Abstract Q Torrens <br /> REQUEST: GLt..P jai a1 L i 1 Dpccu i,^^1,d h'lr7L'r,Sales 0-r pvi.►c//1i <br /> from kJuly 1ot!o in kfrititowii plc 'k' It (gee <br /> *Please note: Applicant may be responsible for additional fees associated with e review of this request. <br /> I HEREBY DECLARE THAT THE ABOVE STATEMENT ARE TRUE. L, (l1�Yr- <br /> Signature <br /> Rezoning $200/acre.minimum$2200.maximum$1,000 Park Fund Dedication Fee <br /> Variance R-1 to R-2-375.all otters Dam Paid <br /> Conditional Use Permit R-1 to R-2-$75.ail others$200 Receipt Number <br /> Code Appeal 375 <br /> Deveiop.iSite Plan Review 5100/acre.minimum 100.maximum$500 Total Fees Paid j{r) s� <br /> Minor Subdivision $150 Dam Paid y Z-•a/� <br /> Major Subdivision 5250 plus$250 deposit Receipt Number '(111-; <br /> Comp. Plan Amendment $200 <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 /> PUO $350 <br /> PUD Amendment 3150 Dam of final action <br /> n / APPROVED ❑ DENIED Q TABIC ❑ <br /> Daze — 3 - Planning Case No. t-1` "�— C� Admin.Account No. r ' <br />