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a <br /> City of Mounds View,MN <br /> Development Application Page 2 <br /> Present Use of Property • <br /> ❑ Undeveloped/Vacant Single Family Dwelling <br /> ❑ Duplex/Two Family Dwelling 0 Multi-family Dwelling <br /> ❑ Business/Commercial Establishment 0 Industrial Establishment <br /> ❑ Other(explain) <br /> Property Classification 0 Abstract 0 Torrens <br /> Description of Proposal A/ --' 69 ;,,, Z6 � X'/O <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) 6cie4t.,0 fr l ( l er <br /> Signature of Property Owner A �( <br /> Name of Property Owner(typed/printed) c›-e4t.,4 m` (Ce% 4111 <br /> Address of Owner 7_c3 `r I Tea►'1 t g- (2 <br /> Phone Number of Owner (Qk 2-/ 1 -(G5 <br /> ************************************************************************************************ <br /> FOR OFFICE USE ONLY <br /> Date of Submittal - S - <br /> Date of Acceptance Assigned to: <br /> Planning Case No. S - P7 ? 60-day Limit 120-day limit <br /> Fees Paid: Account# Check# Receipt# <br /> Application: 0.5-- 00 1,1 n 3 a VC? / S '� <br /> Park Dedication: <br /> Deposits: <br /> Other: • <br /> Total: <br /> N:\DATA\GROUPS\COMDEV\FORMS\DEVAPP.FOR 1/98 <br />