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APPLICAiIT: <br />PROPERTY: <br />PLANNING APPLICATION Data <br />name <br />addre <br />Interest In property (check appropriate box): <br />(owner of record ❑ lessee, operator, manager <br />O contract for deed owner ❑ agreement to purchase <br />❑ other (explain) <br />nt's interest in the property may be <br />Documentary evidence of applica <br />required before final city action on this request. <br />address/general location l LiK <br />present (check appropriate box): <br />❑ undeveloped ❑ business establishment <br />J�single family dwelling ❑ Industrial establishment <br />❑ duplex dwelling ❑ apartments <br />❑ other (explain) <br />ex lain) <br />REQUEST: ( P ` <br />' v ' <br />1 hereby declare that the above statement are true. <br />FOR OFFICE USE ONLY: <br />BASEF FS* <br />subdivision, major ($150) <br />subdivision, minor ($75) <br />rezoning ($50) <br />conditional use (550) <br />variance ($50) <br />code appeal <br />subtutal <br />*Base fees In parenthesis are non- <br />refundable. <br />Park fund dedication <br />date paid <br />receipt k <br />sA'g-'41 <br />ure <br />ADDITIONAL FEES <br />reapportionment <br />public hearing notices <br />staff, consultant reviews <br />misce anenus <br />subtotal _ <br />TOTAL FEES So• ° o <br />date paid d - <br />receipt # <br />