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City of Mounds View,MN <br /> Development Application Page 2 <br /> • <br /> Property Classification Q Abstract _ Torreas <br /> Description of Proposal <br /> BY MY(OUR) SIGNATURE ON THIS APPLICATION,I HEREBY DECLARE THAT,TO THE BEST OF MY <br /> KNOWLEDGE,THE INFORMATION PROVIDED IS TRUE AND ACCURATE. <br /> Signature of Applicant <br /> Name of Applicant(typed/printed) <br /> Signature of Property Owner <br /> Name of Property Owner(typed/printed) J 'z -643D LARec LA- 4 I re_."? <br /> • <br /> FOR OFFICE USE ONLY <br /> Date of Submittal <br /> Date of Acce,rance h=/ q -G 7Assigned to: <br /> Planning Case No. 503— q 60-day Limit ►0 14- ; 120-day limit <br /> Fees Paid_ Account r C:ieck.r ('tJ <br /> /_ <br /> Application: 7S-O O J (/ <br /> Park Dedication: <br /> Deposits: <br /> Other: <br /> Total: <br /> C'.OFFiC7 WPWZIIWPDOCS1AD;bt NTORMStDEVAPP.FOR <br />