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City of Mounds View,MN <br /> Development Application Page 2 <br /> Present Use of Property • <br /> Undeveloped/Vacant 0 Single Family Dwelling <br /> Duplex/Two Family Dwelling ❑ Multi-family Dwelling <br /> C Business/Commercial Establishment ❑ Industrial Establishment <br /> ❑ Other(explain) <br /> Property Classification •❑ Abstract 0 Torrens <br /> Description of Proposal �- <br /> Gc Ott D d of 1 01/16 <br /> 1/Al2/F+NLE t ALL.Ot..J trXPq-14-40e!a 4-IVIAJ& SPACC tJI 70 Pit., d=am `T <br /> BY MY(OUR)SIGNATURE ON THIS APPLICATION,I HEREBY DECLARE THAT,TO THE BEST OF MY <br /> KNOWLEDGE,THE INFORMATION PRO • IS TRUE AND ACC TE. <br /> Signature of Applicant rr't,-,1I i't/ <br /> Name of Applicant(typed/printed) b i J m q.. ict l/J ik)0 o' -1 t, <br /> Signature of Property Owner �Cl>^- .� /4/1/`11) <br /> Name of Property Owner(typed/printed) 12)0/)v't kit in) 2 0` 110 <br /> Address of Owner J �e) 7-- <br /> Phone Number of Owner t, I y�.—.— (erl —• 0 0 I)2 <br /> *********** ********************************* <br /> FOR OFFICE USE ONLY <br /> Date of Submittal .3-i-`I 1 <br /> Date of Acceptance 3 -► -ti q Assigned to: '3 i rne. <br /> Planning Case No. 60-day Limit Li-3 D-`i'i l20-day limit (0- 19- <br /> SSon c\ <br /> Fees Paid: Account# Check# Receipt# <br /> Application: IV. 100 00 <br /> Park Dedication: <br /> Deposits: <br /> Other: • <br /> Total: <br /> N:\DATA\GROUPS\COMDEV\FORMS\DEVAPP.FOR 1/98 <br />