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PLANNING APPLICATION Date <br />APPLIr0T: nano i[....i i<tnePr_OCr�ff phoneq�! <br />-T <br />address POSPA 3CV-1`3 NOLS Mnl aitl3i <br />Interest In property (check appropriate box): �^ <br />'Wowner of record O lessee, operator, manager <br />17 contract for deed owner 17 agreement to purchase <br />Q'other (axplain) H.L,h:r y+,,ftr, - Neriaa-'� <br />Documentary evidence of applicant's interest in the property may be -- <br />required before final city action on this request. <br />PROPERTY. address/general location r-Lj-A <br />//[td <br />al <br />legal owner: name/address <br />or <br />present use (check appropriate box): <br />❑ undeveloped ❑ business establishment <br />❑ single family dwellinn ❑ industrial establishment <br />* duplex dwelling ❑ apartments <br />❑ other (explain) <br />REQUEST: (explain) <br />iC <br />I hereby declare that the above statem.:its are :rue. <br />FOR OFFICE USE OILY: <br />BASE FEE" <br />subdivision, major ($150) rSD.a J <br />subdivision, minor ($79 <br />rezoning ($50) <br />conditional use ($50) <br />variance ($50) �y - <br />"1 code appeal ($50) _ <br />subtotal Is no <br />*Base fees In parenthesis are non- <br />refundable. <br />r <br />Park fund dedication <br />O date paid <br />receipt $ —_ <br />ADDITIONAL FEES <br />reapportionnwnt — <br />pul-lic tearinu notires _ <br />staff, consultant reviews <br />soi%ccIIanetw% <br />subtotal _ <br />TOTAL FEES <br />date paid .1. <br />receipt / ,,jj <br />., VI no 1./i'/ :; <br />rr . /srr rp j ,IS <br />