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Mounds View Planning Applicat,�n <br />Present Use of Properly <br />Property Classification ❑ Abstract ❑ Torrens <br />Description of Proposal (attach additional supporting d cumentation if ne�essa ,ry _ <br />,P% q-� S/�� �� cT �-�`�c rP S'/� �S /30�-� wi�e <br />�� <br />Page 2 <br />� f./���"r' �c./�q T� ��-f=P�T Q-��d �'%�� �� r?di �ei <br />�'� (�C'� -% W / i �vl/ /D T 1 �� J�� K�G `��1 T�.0 fC. 2 � L�c rC'.�J <br />Please Note: Applicants are responsible for all costs incurred associated with the filing, review and processing of this application. <br />Such fees are to be paid in escrow up front or upon receipt of statement from the City of Mounds View. Fees may include but are <br />not limited to costs for consultants retained by the Ciry, consultant planning services, attomey, and engineer fees. A deposit may <br />also be required to cover costs of public notices, materials and staff time spent in the review, research or preparation of materials <br />associated with this application. The applicant shall be responsible for all reasonable incurred costs in excess of the initial deposit <br />amount. Any portion of the deposit not spent or encumbered shall be refunded to the applicant within 30 days after consideration <br />of the application is completed. Payment of park dedication fees is required with subdivision applications. <br />I ACKNOWLEDGE THAT I have read all of the information listed in the Planning Application and fully understand that I am <br />responsible for all costs incurred by the City related to the processing of this application. <br />_ <br />�--��--_ 9� �- �� <br />Applica Date <br />BY MY (OUR) SIGNATURE ON THIS APPLICATION, I HEREBY DECLARE THAT, TO THE <br />BEST OF MY KNOWLEDGE, THE INFORMATION PROVIDED IS TRUE AND ACCURATE. <br />Name of Applicant ( <br />Signature of <br />� <br />/o�y �� �,�'��,� <br />Name of Property Owner (typed/printed) �f�`'/'� �1��'^ <br />� <br />��-« <br />Signature of Properly Owner _ � � /S1'f�--- <br />Address of Owner �yd� c�"r�"�/�� � /f � .���'� �.r �i �'k— � �i� ,S-f%/� <br />Phone Number of Owner ��-� ��o ' `� ��1/ <br />E-m a i I ��/T Oc c.�- f,�w--1 ��,� �- ��.�r/� .� c i� <br />**************************************************************************************** <br />FOR OFFICE USE ONLY <br />Date of Submittal �- �`� 3 Date of Acceptance: �—$- D3 <br />60-day Limit 120-day limit: <br />Planning Case No(s) I� / D 3 � a� Assigned to: <br />Fees Paid: Account # Check # Receipt # <br />Application: o?S� • Oo ,/a D_3cj�i� �r��(,p l S 5aS <br />Park Dedication: <br />Deposits: <br />Other: <br />Total: <br />t oioz <br />