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•City of Mounds View,MN <br /> Development Application <br /> Page 2 <br /> Present Use of Property <br /> • <br /> • ❑ Undeveloped/Vacant ;r ❑ Single Family Dwelling <br /> 0 Duplex/Two Family Dwelling 0 Multi-family Dwelling <br /> Business/Commercial Establishment ❑ Industrial Establishment <br /> Other(explain) <br /> Property Classification ❑ Abstract 0 Torrens <br /> Description of Proposal '' 1 <br /> Lut �J . � �r�rlV• .• �� �_ <br /> W 11� � ' fi <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 C !1-z> 42't( <br /> Name of Applicant(typed/printed) • Gl t C21a1 e Fy G t l 6 <br /> ak Signature of Property Owner / • / <br /> Name of Property Owner(typed/printed) : !� � h'f'I . p ►'S e S cin 5+€Øn n i e kG <br /> Address of Owner _ - 22 Z 7 uh e'V t. C(+7 A✓e , <br /> S4: PAkL , _AN 5- 51y <br /> Phone Number of Owner C6 12.) 6 ,-16 — 7q0 I <br /> ************************************************************************************************ <br /> FOR OFFICE USE ONLY <br /> Date of Submittal ;Pj-—J`6 <br /> Date of Acceptance Assigned to: <br /> Planning Case No. <br /> —3:g";7-(6 `1' 60-day Limit 120-day limit <br /> • <br /> Fees Paid: Account;# Check 4 • Receipt 4 <br /> Application: <br /> Park Dedication: <br /> Deposits: <br /> ether. <br /> Total: <br /> N:1DATA\GROUPS1CO,NIDEVIFORNISTE VAPP.FOR <br /> 1/98 <br />