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City of Mounds View, MN <br /> Development Application Pagel <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 0 Industrial Establishment <br /> ❑ Other(explain) <br /> Property Classification 0 Abstract ❑ Torrens <br /> �' ' <br /> Descript'on of P oposal GUL W `S 1 / `/./ 0,6t. e �./.�"�iv (l� �/0 /Z� OYi t. <br /> OU2 rraM/A - 3 <br /> 5' ,1 A /i �.� /k. <br /> BY MY(OUR)SIGNATURE ON THIS APPLICATION,I HEREBY DECLARE THAT,TO THE BEST OF MY <br /> KNOWLEDGE,THE INFORMATION PROVIDED <br /> ,IISTRUE AND ACCURATE. <br /> Signature of Applicant / J Q,'1 A &c r N <br /> Name of Applicant(typed/printed) Ai‘ <br /> Signature of Property Owner <br /> Name of Property Owner(typed/printed) (hI/-1 ' £ LP 0�✓ • <br /> Address of Owner 7;3( r k U r`& ) /E'. 4Jk.C..( <br /> filts tbktic 4../1.,1,.r" Gas/ 63-5-- /K <br /> Phone Number of Owner �J 8b J 3'0 • ""{' �J0 <br /> r (,- <br /> 0 Y J ' <br /> /4)a.-10x/4)a.-10xIZD�_sJ <br /> ****************************************************************** *** ***** `**********' <br /> FOR OFFICE USE ONLY <br /> Date of Submittal 9 9 <br /> Date of Acceptance Assigned to: <br /> Planning Case No. $'5 3 •9 9 60-day Limit 120-day limit <br /> Fees Paid: Account# Check# Receipt# <br /> Application: f 0 0 • OC Too 3 16 ..IL J ) I'('1 21-04 <br /> Park Dedication: <br /> Deposits: <br /> Other: - <br /> Total: • <br /> N:\DATA\GROUPS\COMDEV\FORMS\DEVAPP.FOR 1/98 <br />