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PLANNING APPLICATION Date '�I C U <br />APPL,rAwT: name I 11 METIItIEiL.�iliti'1_tJC phonecr�i/�-47 <br />address IM 1J),ldtSSIPPI'cr . &QLid fJ Sti4 3Z <br />interest In property (check apprrq;ri,,te oox). <br />n owner of record 0 le%see, operator, manager <br />contract for deed owner `� agreement to purchase <br />O other (explain) <br />Documentary evidence of applicant's interest In the property may be <br />required before final city aetior on this request. / <br />PkOPERTY: address/gdneral location <br />--- <br />regal owner: name/address <br />present use (check appropriate box): <br />0 undevcl peJ O business establishment <br />Jd single family dwelling 0 industriel establishment <br />duplex dwelling 0 apartments <br />D other (explain) <br />k[QUEST: (explain)TO <br />I hereby declare thit t',e above stalements wire true AL <br />\ t°ig <br />FOR OFFICE USE ONLY; <br />BASF r[FSs <br />suodivision, major <br />($1501 1r y <br />subd,vlsion, minor <br />($75) <br />rezoning <br />_ <br />($50) <br />conditional use <br />($50) <br />variance <br />($50) <br />code appeal <br />(550) <br />subtutaI <br />*Base fees In parenthesis are non- <br />refundable. <br />%ark fund dedication <br />date paid _ <br />receipt / <br />ADDITIONAL FEES <br />n appur t i onmr t, t <br />public hearing notices <br />%taff, consultant reviews lttp <br />Mi SCC I lanean <br />subtotal <br />TOTAL FEES 3S0 <br />date paid <br />receipt J 75 <br />