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Present Use of Property <br />Property Classification <br />L Abstract <br />❑ Torrens <br />(attach additional supporting documentation if necessary) <br />,..,.., �_. -1 .k. „I<o K I,__._" '_-_ w:\\ be - <br />Please Note: Application fees are nonrefundable. Applicants are responsible for all costs in excessof the application fee incurred by <br />the City in the processing of this application. Such excess fees are to be paid upon receipt of statement from the City of Mounds <br />View. Excess fees may include, but shall not be limited to, photocopy costs, staff time, and fees for planning consultants, attorneys <br />and engineers. In some cases, a deposit may be required in advance to cover any anticipated excess costs associated with this <br />application. (If a deposit is required, the applicant shall remain responsible for all reasonable incurred costs in excess of the <br />application fee and deposit amount.) <br />I ACKNOWLEDGE THAT I have read all of the information listed in the Planning Application and fully understand that I am responsible <br />for all co incurred y he City related to the processing of this application. <br />Applica t 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 (typed//prriinte i�ev N Hv��-vers <br />Signature of Applicant <br />Name of Property Owner (oped/prl ed) v� so <br />Signature of Property Owner <br />Address of Owner e\ � t+L �- � 'k� eXiN�i �� SS l0 <br />Phone Number of Owner-bi ?--e& <br />E-mail of Owner <br />FOR OFFICE USE ONLY <br />Date of Submittal 3 -3 - 02 Date of Acceptance: <br />60 -day Limit 120 -day limit: <br />Planning Case No(s) (!,Lc ;. ool -oo / Assigned to: <br />Application: <br />Park Dedication. <br />Deposits: <br />Other: <br />Total: <br />Fees Paid: Account # Check # Receipt # <br />!0;'i 5 - 00 06- LZ35-`5_ <br />Page 2 of 2 <br />