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Application fees are non-refundable. <br />Present Use of Property L-. <br />Property Classification <br />Description of F <br />4- <br />I," <br />,X Abstract <br />(attach additional <br />94'11 Fa i' <br />rj-% <br />❑ Torrens <br />if necessary) <br />f� <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 />Rica= Neal: Application fees are noorefunOblc. Applicants are responsible for all <br />costs in excess of the application fee incurred by the City in the processing of this <br />application. Such excess fees are to be paid upon receipt of statement from the City of <br />Mounds View. Excess fees may include, but shall not be limited to, photocopy costs, <br />staff time, and fees for planning consultants, attorneys and engineers. In some cases, a <br />deposit may be required in advance to cover any anticipated excess costs associated <br />with this application. (If a deposit is required, the applicant shall remain responsible for <br />all reasonable incurred costs in excess of the application fee and deposit amount.) <br />I ACKNOWLEDGE THAT I have read all of the information listed in the Planning <br />Application and fully understand that I am responsible for all costs incurred by the City <br />related to the processing of this application. <br />Name of Applicant (typX <br />Signature of Applicant <br />Name of Property Owner (tyr <br />Signature of Property Owner <br />Address of Owner S" <br />LowJF <br />R , n, W1.1i Ll rl: <br />Phone Number of Owner 2c> <br />E-mail of Owner % C�er► g,� `, q #.t <br />ILLO <br />Date of Submittal _ <br />60-day Limit <br />Planning Case No(s) <br />Application: <br />Park Dedication: <br />Deposits: <br />Other: <br />Total: <br />Date of Acceptance: <br />120-day limit: <br />Assigned to: <br />(Fees Paid: Account # <br />Page 2 of 2 <br />C%Credit # Jo Receipt # <br />