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9/12/23, 3:53 PM <br />Revize Online Forms <br />Chicken/Duck Keeping License Application <br />Submitted by: Saif Alnabi <br />Submitted On: 2023-09-12 15:34:15 <br />Submission IP: (50.237.61.66) <br />proxy-IP (raw- fl <br />Status: Open <br />Priority: Normal <br />Attachments <br />• Coop Site Planjpg-- 2023-09-12 03:34:15 pm <br />MOUNnsIViEw <br />Assigned To: Barb Benesch <br />Due Date: Open <br />Print <br />ANNUAL CHICKEN/DUCK-KEEPING <br />Valid from January 1 - December 31 <br />LICENSE APPLICATION <br />2401 Mounds View Blvd. I Mounds View, MN 55112 <br />(763) 717-4000 1 Fax (763) 717-4019 <br />info@moundsviewmn.org <br />Requirements relating to the keeping of chickens and ducks is located in Mounds View City Code Chapter 90.005. All permit holders are <br />required to be familiar with the provisions of this chapter. In submitting a license application, the applicant declares that they meet the <br />requirements for issue of said permit, and that such location will be operated in compliance with the adopted regulations and <br />ordinances. All chicken & duck keeping licenses are valid from January 1 through December 31 of each year. The application fee will not be <br />pro -rated and is non-refundable. <br />New Application $100 (Site Plan Required) <br />❑ Renewal Application $30 <br />* Applicant First Name <br />Saif <br />Street Address <br />7624 Spring Lake Rd <br />Phone 1 <br />6125174754 <br />* Applicant Last Name <br />Alnabi <br />0 Chickens # of Chickens <br />❑ Ducks 8 <br />* Email <br />City <br />Mounds View <br />Phone 2 <br />Alnabi.s@hotmail.com <br />Valid Email Required <br />State <br />Mn <br />Ex. (123) 456-7890 <br />If the applicant is not the owner of the property, please complete the section below: <br />Owner Name <br />Safa Gamam <br />Phone 1 <br />7632450756 <br />Street Address <br />7624 Spring Lake Rd <br /># of Ducks <br />City <br />Mounds view <br />Email <br />safagamam@gmail.com <br />Valid Email Required <br />Zip Code <br />55112 <br />State Zip <br />Mn 55112 <br />https://moundsviewmn.rja.revize.com/reports/387454 1/2 <br />