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Mounds View Planning ,4p�lic�tion <br />� � .�- <br />� <br />Page 2 <br />�r�pe�j �t���s�c�tac�r� ❑ Abstraet � Torrer�s <br />D��criptiors o� Propos�l (atiach additional suppo�ting documentation if necessary) 9�r x;� <br />. � . � <br />,�' ��°�'" �.�iG�°' . 9L-1 f � -�°�'- � <br />Please kVote: Applicants are responsible tor all costs incurred assotiated with Yhe filing, review and processing of this appiieation. <br />Such fees are to be paid in escrow up front or upon receipt of statement from the City of Mounds �ew. Fees may include but are <br />not timited to costs for consultants retained by the City, tonsultant planning services, attorney, and engineer fees. A deposit may <br />aiso be required ta caver costs of pubfic natices, materials and staff time spent in the review, research or preparation of materials <br />associated with this appf ication. The appEicant sha11 be responsible for al! reasonable incurred costs in excess of the initial depasit <br />amaunt. Any portion o€ the deposit not spent or encumbered shall be refunded to the applieant within 3D days after wnsideration <br />of the applieation is completed. Paymeng of park dedicatian fees Is required with subdivision applications. <br />I ACKNOWLEDGE THAT I have read atl of the informatian fisted in the Planning Applieakion and fuily understand that I arn <br />responsible for afl costs incurred by e City related to the processing of Yhfs application. <br />� � � �,�r �, �. � � <br />Applicant � Date � <br />'� , ; • � i. � ' � i : i, #i � <br />* - ; - �� : � ��. � � � <br />r . ; ,.. . . � <br />� ., <br />_ ,., <br />l ; ' �: : . .�. ;t� K . . Y . �. <br />, :` � . . , <br />1Vame of Appficant <br />Signature of Applic� <br />Name of Property Owner (typed/print�d) �1.v,2�� , _ ,f � �-� �J�� <br />Signature of Pr�pe <br />Address of Qwner <br />Phone Number of i <br />I� <br />*�*��*=x*�m�x�***��*������*��:�*x�*��*�x��,���?��*��**�x**�zm*���**:�����*x���*x��*�***�**��*x:*� �� <br />�' � <br />FOR OFFICE 6�SE O�LY �:. . , ' n: <br />�� �c ��� � . ' <br />�ate of Subrnitta! 7-�- 0 3 Date of Aeceptanee: <br />60-day Limit 120-day limit: <br />Planning Case No(s} +^� � 0 3- o o a Assigned to: �� <br />Fees paid: Account # Cheek # R�cei t#� <br />Applicatian: �-s � • °° Q p � <br />Park Dedication: <br />Depasits: <br />Other: <br />TotaE: <br />� oioz <br />