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City of Mounds View,MN Page 2 <br /> Development Application <br /> Present Use of Property <br /> ❑ Undeveloped/Vacant ❑ 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 ❑ Abstract ❑ 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 N' AND ACCURATE <br /> 0 <br /> Signature of Applicant �+ <br /> Name of Applicant(typed/printed) ,-‘c rf 1 V • esh n, S 6 °N <br /> Signature of Property Owner <br /> Name of Property Owner(typed/printed) <br /> Address of Owner <br /> ..O / (f /L 6 (J r +Z EAJ X. <br /> Phone Number of Owner • 4 6 6r of <br /> ************************************************************************************************ <br /> FOR OFFICE USE ONLY <br /> Date of Submittal —1 - 3 Assigned to: <br /> Date of Acceptance 120-daylimit <br /> Planning Case No. _'i 7 O " ? 60-day Limit <br /> Check# Receipt# <br /> Account# <br /> Fees Paid: �a� 'y� <br /> Application: A5 )O''� _-3 9L -i <br /> Park Dedication: <br /> Deposits: <br /> Other: <br /> Total: <br /> 1/98 <br /> N:\DATA\GROUPS\COMDEV\FORIv1S\DEVAPP.FOR <br />