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City of Mounds View, MN <br /> Development Application Page 2 <br /> Present Use of Property • <br /> ❑ Undeveloped/Vacant X Single Family Dwelling <br /> ❑ Duplex/Two Family Dwelling ❑ Multi-family Dwelling <br /> O Business/Commercial Establishment ❑ Industrial Establishment <br /> a Other(explain) <br /> Property Classification 0 Abstract Torrens <br /> Description of Proposal <br /> pLemSe see 4.# ached O(OCumy,CKql-sc <br /> • <br /> BY MY(OUR)SIGNATURE ON THIS APPLICATION,I HEREBY DECLARE THAT,TO THE BEST OF MY <br /> KNOWLEDGE,THE INFORMATION PROVIDED <br /> CD 's <br /> ACCURATE. <br /> Signature of Applicant (Z) -o G' exeirn‘c <br /> Name of Applicant(typed/printed) orc,4-4 e ecb1 hr!Cd <br /> Signature of Property Owner <br /> c) : - • <br /> Name of Property Owner(typed/printed) 'Dora+k e e t e.4-n!c. <br /> Address of Owner 78as. t LOf i a Circ Le <br /> Mou.tAds View HlU ssitZ <br /> Phone Number of Owner 6 12- 717 2.8 ifs- <br /> FOR <br /> sFOR OFFICE USE ONLY <br /> Date of Submittal 3-“- <br /> Date <br /> --“-Date of Acceptance Assigned to: <br /> Planning Case No. j,5 1— of 9\ 60-day Limit 120-day limit <br /> Fees Paid: Account# Check# Receipt# <br /> Application: 1190.0 0 1 0 a 31f lP c /3 fo2, <br /> Park Dedication: <br /> Deposits: <br /> Other: • <br /> Total: <br /> N:\DATA\GROUPS\COMDEV\FORMS\DEVAPP.FOR 1/98 <br />