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City of Mounds View,MN <br /> Development Application Page 2 <br /> • Present Use of Property <br /> ❑ Undeveloped/Vacant ti 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 '6C Torrens 6.,0ft-1-1 r s o.?iso 044 b`` CC cP`"P(4 tc 1e ) <br /> Description of Proposal k;ids A.t.W S U,vc.V Ute, `o t e 4 of C.i..I.Alt... -I <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 .CCURATE. , <br /> Signature of P '► teerrt y <br /> Name of A t(typed/printed) CW,i 5r-i av Ale,*1.. <br /> Signature of Property Owner <br /> 444114j .&-tert-A-: . <br /> • Name of Property Owner(typed/printed) N1 i Ck&c1 6 reo.. <br /> Address of Owner iSO I w o ackl2 ''J k" <br /> Mouods VieLtil gra <br /> Phone Number of Owner ( (a - 7$610-75%6 <br /> ************ *********************************************************************************** <br /> FOR OFFICE USE ONLY <br /> Date of Submittal 6-I? - 9 9 <br /> Date of Acceptance Assigned to: <br /> Planning Case No. St /— 9 el 60-day Limit 120-day limit <br /> Fees Paid: Account# Check# rR�eiSI� <br /> Application: / 0 0 . 0 0 /O D —:4t 7P 7 g 3 <br /> Park Dedication: <br /> Deposits: <br /> 0 Other: <br /> Total: <br /> N:\DATA\GROUPS\COMDEV\FORMS\DEVAPP.FOR 1/98 <br />