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Application fees are non-refundable. <br />Present Use of Property �%%uyk j)J �%oVAk <br />Property Classification <br />Description of <br />❑ Abstract <br />Torrens <br />(attach additional supporting documentation if necessary) _ aw h tv% <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 />Please Note: Application fees are nonrefundable. Applicants are responsible for all costs <br />incurred associated with the filing, review and processing of development applications. Such <br />fees to be paid in escrow up front or upon receipt of statement from the City of Mounds <br />View. Fees may include, but are not limited to, costs for consultants retained by the City, <br />consultant planning services, attorney, and engineer fees. A deposit may also be required to <br />cover costs of public notices, materials and staff time spent in the review, research or <br />preparation of materials associated with each application. The applicant shall be responsible <br />for all reasonable incurred costs in excess of the initial fee and/or deposit amount. Any <br />portion of the deposit not spent or encumbered shall be refunded to the applicant within 30 <br />days after consideration of the application is completed. Payment of park dedication fees is <br />required with subdivision applications. Application fees are not refundable. <br />I ACKNOWLEDGE THAT I have read all of the information listed in the Planning Application <br />and fully understand that I am responsible for all costs incurred by the City related to the <br />processing of this application. ll <br />Name of Applicant (typed/printed) JC6" ! <br />Signature of Applicant �� x tt <br />Name of Property Owner (typed/printed) <br />Signature of Property Owner A"_ L. <br />Address of Owner 117 1 W' . Vo� Sh!�tAA &�S& 93701 <br />Phone Number of Owner ME IV I N i Z <br />E-mail of Owner 1e5L be" iL WA ano:t-CvtA <br />FOR OFFICE USE ONLY: <br />Date of Submittal <br />60-day Limit <br />Planning Case No(s) <br />Application: <br />Park Dedication: <br />Escrow, <br />Other: <br />Total: <br />Date of Acceptance: <br />120-day limit: <br />Assigned to: <br />Fees Paid: Account # Check/Credit # <br />Receipt # <br />