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City of Mounds View,MN <br /> Development Application Page 2 <br /> Present Use of Property <br /> I ❑ Undeveloped/Vacant Single Family Dwelling <br /> ❑ Duplex/Two Family Dwelling ❑ Multi-family Dwelling <br /> ❑ Business/Commercial Establishment 0 Industrial Establishment <br /> O Other(explain) <br /> Property Classification 0 Abstract X- ' ,Torrens <br /> Desc ;ption.of P oposal ti(0A Cit 4- LI-1161a-11 � r)d <br /> ADS W $'Q/41 <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 iki/.. D -ii <br /> .� m <br /> Name of Applicant(typed/printed) A l at1 1'11 i I <br /> ` Jozyg <br /> Signature of Property Owner D Crk.44 if G n / <br /> Name of Property Owner(typed/printed)ii <br /> X11 �'�Ca1iL (��� <br /> Address of Owner L� t I) fl I)C Cd Road <br /> Mourth \Jta,iO 11rY11.3 35 I ! 9 <br /> Phone Number of Owner LP l —ricl a—V 1 a5 r enre <br /> ,lobi-- 444-(495 Alanhs wort <br /> (ol a - 503 -63)-10 -1-arrinrtit U rIL <br /> FOR OFFICE USE ONLY <br /> Date of Submittal q—1 O — "t "1 <br /> Date of Acceptance Assigned to: <br /> Planning Case No. -7/ — C) 9 60-day Limit 120-day limit <br /> Fees Paid: t, Account# Check# Receipt# <br /> Application: S — /0 0 3?"7 ©1 Gi/ 9i 33 10 <br /> Park Dedication: <br /> Deposits: <br /> Other: <br /> 8 Total: <br /> N:\DATA\GROUPS\COMDEV\FORMS\DEVAPP.FOR 1/98 <br />