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City of Mounds View. Mt <br /> Development Application Page 2 <br /> Present Use of Property <br /> ❑ Undeveloped/Vacant Single Family Dwelling <br /> • ❑ Duplex Two Family Dwelling ❑ Multi-family Dwelling <br /> ❑ Business/Commercial Establishment a Industrial Establishment <br /> ❑ Other(explain) <br /> Property Classification ❑ Abstract ❑ Torrens <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. "3`5:.1`= -, <br /> Signature of Applicant <br /> Name of Applicant(typed/printed) <br /> Signature of Property Owner <br /> '`^a�U,{�R <br /> .Name of PropertyOwner(typed/printed) _ <br /> • <br /> Address of Owner _. - • <br /> a0� <br /> Ma <br /> u A:le;5 S V 1Gc4 vh. t {-Z :.. <br /> Phone Number of Owner b)� 1 czb <br /> • <br /> FOR OFFICE USE ONLY • <br /> Date of Submittal 7—/o — <br /> Date of Acceptance .• .. Assigned to: L H s: <br /> Planning Case No. - • 3'31— g 60-day Limit 120-day limit <br /> Fees Paid: . . .Account* Check# Receipt# <br /> Application:. ,lt ?5 .. 973 Sr 5 433 9 <br /> Park Dedication: <br /> Deposits: <br /> Other <br /> • <br /> • Total: <br /> N:\DATA\GROUPSICOMDEVIFORMSIDEVAPP.FOR <br /> 1198 <br />