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PLANNING APPLICATION <br />r_ <br />Date - <br />APPLICANT: nameott.�3'rN > -)_Alec:, hC_ Pnoner�r��-4� <br />address 111tk6tsstPPt Ss. F�� Mt.) S4-43? <br />Interest In property (check appropriate Lox): <br />❑ owner of record ❑ le%see, operator, manager <br />❑ contract for deed owner ayrrement to purchase <br />❑ other (explain) <br />Ducunentary evidence of applicant's interest In the properly nay be <br />required before final city actiun on Oils request. ' <br />PNOPERTY: address/general location Q�J�lJ�k7CD VrhySal� S4AAxftrn-.n <br />legal owner: name/address T)AcIy`N t:_kQ CnAAK F7 <br />present use (check appropriate box): <br />❑ undeveloped ❑ business establishment <br />slnyle family dwelling D inJustrial estab] ishent <br />❑ duplex dwelling D apartments <br />❑ other (explain) _ _ <br />C Z <br />xEQuEST: (exolain) <br />TO� >�iz_-K1i�,►��. _ <br />I hereby declare that the a:+ove statemaus arc In.m <br />FOR OFFICE USE ONLY: <br />EASE FEES* <br />subdivision, major <br />($I50) ItA? <br />subdivision, minor <br />($75) <br />rezoning <br />($iO) — _ <br />conditional use <br />(SSO) <br />varl.aca <br />(S50) <br />code appeal <br />OW) <br />subtotal <br />*Base fees In parenthesis are non- <br />refundable. <br />Park fold dedleatlon <br />date paid- <br />reccil,t a — <br />mgnature <br />AU017ICNAL FEES <br />r r appur t i ordw n t <br />public Waring notices <br />+t,mff, consult .nt revidvrs i JJ <br />,xiscclleneous <br />subtotal <br />TOTAL FEES S S O <br />date paid; -YS <br />receipt / 75-, <br />