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City of Mounds View,MN <br /> Development Application Page 2 <br /> S <br /> Present Use of Property <br /> ❑ Undeveloped/Vacant 0 Single Family Dwelling <br /> Duplex/Two Family Dwelling 0 Multi-family Dwelling <br /> ❑s Business/Commercial Establishment • 0 Industrial Establishment <br /> ❑ Other(explain) <br /> Property Classification 0 Abstract 0 Torrens <br /> Description of Proposal <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 -C-.-'- ' ir/ • <br /> Name of Applicant(typed/printed) NA L.Z.H"1 C 1--E-67-7.-- <br /> • <br /> Signature of Property Owner CL:-T ,'—- - ' mak _.)--7"1 <br /> Nam rroperty O.ue:(tyred`pri^t,x1) Lt-ixal I L — ,.'.L/ O L E <br /> Address of Owner �' L— ), off , � /-J 144 , /t,/ <br /> cH��-vl z-. . Y-A1 . ..s-- -7)-----6-, <br /> Phone Number of Owner ( si ) 4 -i-t'—'6%/(:).C- <br /> 44**44.** #****?k—FIs#************************************************** <br /> FOR OFFICE USE ONLY <br /> Date of Submittal T '') <br /> Date of Acceptance Assigned to: <br /> Planning Case No. 60-day Limit 120-day limit <br /> Fees Paid: Account# Check# Receipt#. <br /> Application: O,•00 i v r,) -.�4f Z / -7,A 5 / Wiz?/ 5 <br /> Park Dedication: <br /> Deposits: <br /> Other: <br /> • Total: <br /> N:\DATA\GROUPS\COMDEV\FORMS\DEVAPP.FOR 1/98 <br />