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Data <br />PLAN111M AI.1•I.IU1111N1 -- <br />phule 7 ( 4 f 3 <br />APPLICANT: ^+e1C � 7 A,)$ UL ST. �w�,.� - ---- <br />address 2505�2_— <br />interest In prc"rly (check appropriate box): <br />0 owner of record 13 le+see, Upr'dtor, manager <br />p contract for deed peer' <br />�agren:.rnt to purchase <br />(explain) <br />O other ___----------- _� <br />1 rlir.,nt's inlrn••.t in the property r«ay t. <br />GOG,exenrary CviJCnae of •f'I <br />required beture final city acliun on this '••quest. <br />I eo ele.e .4/. <br />I NOrEHTY; address/gtnaral Inc«Bunt <br />_ <br />� <br />legal ot+nr. ename/address Lewd tN • -- <br />present use (check appropriate box):undevelopeJ O bu,ines< estobiishxwnt <br />0 single family dwrllinv O indu.triul eslabilsnment <br />U duplex duelling U •rpnr Unral. <br />0 other (rxplain) <br />AEQUESY: (explain) _ __L�_5 C = _ <br />awit <br />1 bereby declare lhot the above statern nls are to w:. <br />f0A OFFIcr usE ONLY: <br />SASE FEW <br />subdivislon, major <br />subdivision, minor ($70 <br />rowning <br />(Si0) _ <br />conditional usa <br />variance ($So) <br />code appeal ($50) .�____..... <br />s„blutal <br />eSase fees In parenthesis are non, <br />roftu,dable. <br />park fund dedication <br />date paid _._.__... <br />Au0,I.I.0 »l2 fL$ <br />r,epl,.0 i iunmrul _. <br />+1 1f, hurl'.Ulinn[ reVlcMl ���� . <br />subtotal <br />TOTAL FEES 7 LSC, <br />data paid <br />recelpt / f!(/_ <br />