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City of Mounds View,MN l <br /> Development Application Page 2 <br /> Present Use of Property1111 <br /> ❑ Undeveloped/Vacant ;( Single Family Dwelling <br /> ❑ Duplex/Two Family Dwelling ❑ Multi-family Dwelling <br /> ❑ Business/Commercial Establishment ❑ Industrial Establishment <br /> ❑ Other(explain) <br /> Property Classification Abstract 0 Torrens <br /> Description of Proposal O 2 e GO At /r �4A4/ ce / ,ems tea//6,,e, <br /> 1 tc c e.4 1,0 yes: /etc‘st/ �upc.• f,� d 'j e -tf0 , <br /> 1,0rA tom / /1-oH/ Irf e//P./l xhrepi /7. �y//� �' � S/!, �ff.�_.141, f/fT <br /> X1114' ©r o 4/ <br /> • <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) Ivy ! /N / Gt.), �✓ Ti G • <br /> Signature of Property Owner1111 <br /> Name of Property Owner(typed/printed) 7741-41)Y-t7 h2 /1///177'= <br /> Address of Owner .Sf`,'Z 4.1 /Np211 i'7/J A y'Y, <br /> /i'<f�G'i?C!l //l�!!/, ,t/fes .S.'„//• z <br /> Phone Number of Owner 6t2 <br /> `'RCE USE ONLY <br /> Date of Submittal <br /> Date of Acceptance Assigned to: <br /> Planning Case No. S3 3— qfto 60-day Limit 120-day limit <br /> Fees Paid: Account# � Check# Receipt# <br /> Application: 10 0.0e ?0 J-3 4 u,�C i" 7 7 I _� d,5 t Cr <br /> Park Dedication: <br /> Deposits: <br /> Other: • <br /> Total: <br /> N:\DATXGROUPS\COMDEV\FORM[S'DEVAPP.FOR 1198 <br />