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City of Mounds View, M1' <br /> Development Application Page 2 <br /> Present Use of Property <br /> • ❑ Undeveloped/Vacant m? Single Family Dwelling <br /> ❑ Duplex/Two Family Dwelling a Multi-family Dwelling <br /> ❑ Business/Commercial Establishment ❑ 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. ""'" `, J3; ' <br /> Signature of Applicant � - <br /> C� <br /> Name of Applicant(typed/printed) <br /> Signature of Property Owner `-to,„,fk, \e-`C� <br /> Name of Property Owner(typed/printed) ` �- U .`. ,::n <br /> Address of Owner a-1 - ne-341 i0e1 <br /> ..'. ..-..�{--..« .,.,ter <br /> Phone Number of Owner .._. (b12S 1 b <br /> FOR OFFICE USE ONLY <br /> Date of Submittal 7-/o - <br /> Date of Acceptance Assigned to: • :- =: :- <br /> Planning Case No. 5-31-k & 60-day Limit 120-day limit <br /> • <br /> ....,-_e <br /> Fees Paid:_ Account# Check# =Receipt# <br /> Application:. ,IC 75 - . - - - 973 Sl "S 13 3 9 <br /> Park Dedication: <br /> Deposits: <br /> Other: <br /> • Total: -. <br /> N:1DATAUGROUPSICOMDEV1FOR.4iS1DEVAPP.FOR _. /98 <br /> - tai <br />