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City of Mounds View,MN <br /> Development Application Page 2 <br /> Present Use of Property / • <br /> ❑ Undeveloped/Vacant ta' Single Family Dwelling <br /> 0 Duplex/Two Family Dwelling ❑ Multi-family Dwelling <br /> ❑ Business/Commercial Establislunent ❑ Industrial Establishment <br /> ❑ Other(explain) <br /> Property Classification 0 Abstract 0 Torrens / <br /> Description of Proposal �nVp eW[1 4 /9sX 72/'7 /00 / .5-001/-42.rt d us 2_ as s 7/-o e euJ /:44 , 1 <br /> BY MY(OUR) SIGNATURE ON THIS APPLICATION,I HEREBY DECLARE THAT,TO THE BEST OF MY <br /> IC'IOWLEDGE,THE INFORMATION PROVIDED IS TRUE AND ACCURATE. <br /> Signature of Applicant O <br /> Name of Applicant(typed/printed) F,VAa a QV e,,.74 iv <br /> Signature of Property Owner j a wt.e • <br /> Name of Property Owner(typed/printed) 71 <br /> Address of Owner S2Zi L000 fiZle U r <br /> /Pio f1HA) 3-57/2-- <br /> Phone Number of Owner 786 ` 6 860 <br /> FOR OFFICE USE ONLY <br /> Date of Submittal - U - 9 <br /> Date of Acceptance Assigned to: <br /> Planning Case No. 5'6- Llg 60-day Limit 120-day limit <br /> Fees Paid: Account# Check# Receipt <br /> Application: 1 S /OC-50/o -i 9 to 1S 8a.'v <br /> Park Dedication: <br /> Deposits: <br /> Other. • <br /> Total: <br /> • <br /> NMATA\GROUPS\COMDEVTORMS\DEVAPP.FOR <br /> 1/98 <br />