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'__ _ _ ; <br />� _ � � ,._ __ __ _ .__ - ��� <br />Mounds Vievd Planning Applic� ,n <br />Present Use of Property <br />Property Classification f_7 Abstract <br />� <br />O Torrens <br />Description of Proposal (attach additiona� supporting documentation if necessary) <br />Page 2 <br />Please Note: Applicarts are responsible for all costs incurred asor.iated ��i[h the filing, revievd a�d prc[�sing of Uvs applica�on. <br />Such fees are to be paid ln escww up frcnt or upon receipt of statement from the City of 17ounds View. Fees may inr.lude but are <br />not limited to cosLs for consullants relained by [he City, consult2r[ planning services, attorn_y, and engineer fees. A dep�siC may <br />also be requim� to cover cos�s of public notices, rraizrial> and staff lime spent in the reviEw, research or araparatior of materi:,ls <br />zsso`^iated with C�is applira6an. The tpplicant shall be respor,sible for all reasonable inr.urred costs in excess af die initlal deposit <br />amount. My portion of the daposit not spen[ or encumbered shall be 2CUndad to thz appiicant within 3q days after corsideraHon <br />of the avDlicytion is completeJ. Payment of park dedication fcs is required ovith suhdi��ision applicAtions. <br />I pCKNOVJLEGGE THAT I have ead all of 4�e Inforrnavon listcd in the Planning Application and fully underst�nd that I am <br />responslhl2 F�ail cosls i�r�e .tho Gity related m the processing of this application. <br />._..... _ <br />�._ <br />� � ���-�=� °-�d'� �—. <br />A....�:,._., D'dte <br />BY MY (OUR) SIGNATUItE ON THIS APPLYCATION, I HEREBY DECLARE TMAT, TO TNE <br />BEST OF MY KNOWLEDGE, 7HE iNFORMATlON PROVIDED IS TRUE AND ACCURATE. <br />Name of Applitant (typed,rprirted) � _ nl e� �v _ - <br />Signature of Applicant_____ �� _ `�' ' " - l� <br />Name of Property Own �typed/printed) � i'i �o i.. sen� �►�_t'1--, /z O��-L�S J'J <br />Signature of Property Owner __ Lru,�GL 1� �/��%'�' �'"��' <br />Address of O�rner �•�I�c�r;t 17r� /Y1vtG.ds ��+Cc�' �l�.l: 5 S//�- <br />, <br />Phone Number of Owner ��� 3- 7:�s `!� s_� . . <br />E-ma�l of Owner__ � N � `"L�.,�U � � �"''1 . <br />WMx.%;k�I:M*���***�q=��K��*�:W�:�,y:x�kt.t•i:Y#%;# � x#A��:�4A:*�k%:*�#:k�*�*x�W�k:e�KMx:*a:�k�:��k�K�#��k*#*ac*:FapW:kt:F.*�: �:*#* <br />FOR OEFICE USE ONLY <br />Date of Submlttal 1%- �- a.3 Date of Acceptance: _ <br />60-day Limit 120-day limit: <br />Planning Case No(s) Assigned to: __� _ <br />Fees Paid: Account �i Check � <br />Rpplication: /s.�5 • �0 _ '� � � <br />Park Dedication:__ __ <br />Deposits: _ _ _ <br />Other: _ _. — — <br />7olal: <br />Receipt T <br />