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APPLICANT: <br />aar,) <br />( err Fee, <br />Pi.ANNntc AppuCAHON <br />gjsy-r "'t r...,., tA.,; ttr•1ttPS <br />nasc /%IIiCL'� �n �(d> ii�GdtL112iCF.a<Gvj�it" v--- <br />address <br />Interest In property? (check appropriate Fox): <br />O owner of record 0 lessee, operator, eatnager <br />a contract for deed owner a agreement to purchase <br />Cr other (explain) -9 — <br />Documentary evidence of appllran J's inu•r,-st in the property say t <br />required belore final city acliuu on tliis request. <br />PROPERTY: address/general location .-�gatmasn .814 <br />legal owner: name/address / yS(m•• Eenq /'>= <br />present use (check appropriatebox): �•---- •-_ <br />M undeveloped <br />lR single family dweliintl <br />• duplex dwellinq <br />C) other (explain) <br />0 business establishment <br />❑ industrial c,,tablishment <br />❑ aparnmrnh <br />ttFquE$T: (explain) JWjJ Qs,;e__1VJ'?I _—4CKAC2z5A1rl'2j&j .fS-.. <br />r77'4,�/ t IA A! t' A I A J F//— <br />I hereby declare that the above stattaenla are true. - /w[/Lrrr�4i� <br />, ,,ignature <br />FOR OFFICF. USE ONLY: <br />RASE FM* <br />subdivision, major <br />subdivision, minor <br />rezoning <br />conditional us,• <br />variance <br />code appeal <br />i <br />MCI) —_ <br />($50) _ <br />($50) <br />($50) <br />subtotal —_ — <br />"Base fees In parenthesis are none <br />refundable. <br />Park fund dedication <br />date paid <br />receipt I <br />AlID17ICNAL FEES <br />reopportioruxent <br />Public Waring IMtires <br />stiff, con,,ullant revi.nrs JO <br />mi sh e.l IaoerAts <br />d a <br />subtotal �fia _• <br />TOTAL FEES 1/1711ea <br />date paidr0 •�� <br />receipt <br />