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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 /> arc._ Business/Commercial Establishment ❑ Industrial Establishment <br /> ❑ Other(explain) <br /> Property Classification 0 Abstract 0 Torrens 11 <br /> Des ' tion of Proposa �,.:�,�i `�"'�'^� J <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 >---2-%2%4 <br /> �� 9'- <br /> Name of Applicant(typed/printed) C / -4 rr 97-- 6116 <br /> GO Le.se <br /> • Signature of Property Owner _) ,,,„� <br /> Name of Property Owner(typed/printed) C , <br /> Address of Owner <br /> Phone Number of Owner <br /> ********** ** **************************** <br /> FOR OFFICE USE ONLY <br /> Date of Submittal 5- /3- 1 I_ <br /> Date of Acceptance C-. Z( - Cj Assigned to: c--11 <br /> 444 <br /> Planning Case No. s `i= q / 60-day Limit .7-2 5 09 120-day limit i t-25-q 9 <br /> Fees Paid: Account# Check# Receipt# <br /> Application: a 5.0' 0 0 / 0 D 3 p--7 °) 3030 � e &3 <br /> Park Dedication: <br /> Deposits: <br /> Other: <br /> • Total: <br /> N:\DATA\GROUPS\COMDEV\FORMS\DEVAPP.FOR 1/98 <br />