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�____ ____:� .. :_ � .� :w � I <br />Mounds View Planning ApplicG'. ,i � " Page 2 <br />Present Use of <br />Property Classification ❑ Abstract ❑ Torrens <br />Description of Proposal (attach additional supporting documentation if necessary) <br />��d ���11Nc1 S{-� I l ♦e o u,r rw e v4,� o aNa« �lcu� wi f��a a7'1'a�lr r�S�aga <br />Z c3. — G e � � o't <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 Gty, consuitant planning services, attomey, and engineer fees. A deposit may <br />also be required to cover costs of public notices, materials and staff time spent fn tf�e review, research or preparatlon of materials <br />assodated with this applicatlon. The applicant shall be responsible for all reasonable incurred costs in excess of the Inibai 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 />Applicant <br />THAT I have read all of the information listed in the Planning Application and fuily understand that I am <br />coS�tE inr�rjed by the City related to the processing of this appiication. <br />'�- I 7 - D 3 <br />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 (type pri <br />Signature of Applicant <br />Name of Property Owner (� <br />`ft� « k <br />. <br />Signature of Property Owner <br />Address of Owner ?� S o p r�► ��-akt �-a� d <br />Phone Number of Owner (o L Z. -�4b - 0 l$ S <br />E-mail of Owner �' L l.P u b 1� er k� Co«aca.e�- /V iP'' <br />� <br />***********************************�x*********�****************************************** <br />FOR OFFICE USE ONLY <br />Date of Submittal R-i 9- a3 Date of Acceptance: � <br />60-day Limit 120-day limit: <br />Planning Case No(s) �� 3- �a Assigned to: <br />�`��3-d� `� <br />Fees Paid: Account # C� � #� <br />Appli�ation: 1 tio����__ �PL�N"L� ! <br />Park Dedication: � �'�� �� � �► <br />Deposits: <br />Other: <br />Total: <br />Receipt # <br />Jc 9" <br />