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PLANNING APPI.V AT ON <br />note S(iSJbi <br />r <br />r <br />APPLICANT: nalee Jf NIi'�------ -- -------_ phone <br />address/•-__— <br />Interest In properly (check appropriate box): <br />Ell owner of record <br />0 contract for deed owner <br />0 other (explain) <br />0 le+see, operator, men"er <br />tXV•lVree,nenl In por Chafe <br />Documentary evidence of applicant's interest in the property may b- <br />required before final city action on this request. <br />PkOPWY: addr••,s/.i•.«,al Inialinn d�jQ't-- /ti(/S_J7¢N(. _� �-._ _- <br />legal owrwr: name/address <br />present use (check appropriate boa): <br />Xundeveluped n bu•.ir,ess establistmwit <br />Cl single family dwellinq 0 industrial establishment <br />• duplex J rlllnit t1 al-arinwnt <br />0 other (explain) <br />rtfQUEST: (explain) "se2>,IVl/— <br />I hereby declare that live above state'rwnts are Ire.•. <br />1 giturs <br />itlti. (iv��d <br />roft ou w USE ONLY: <br />BASE FEES* <br />,ubdivision, manor <br />subdivision, minor <br />rezoning <br />conditional use <br />var iunce <br />code appeal <br />($150) <br />($79 <br />($50) <br />($A <br />($So) <br />($50) <br />anhtuta) —.,— -- <br />t "lase fees In parenthesis air non- <br />` refundable. <br />Park fund Judlt:,l ion <br />date Paid - - <br />receipt <br />AODI11.0AL IEES <br />I r.•I,Inn t ivnewul __._ <br />pid,li. lwaeh.g irntires Sp_-_ <br />enn•.ultant reviews�)O/r�. <br />mi.., e I lam•lel, <br />subtotal <br />(- TOiAl FEES - +0p — <br />dale paid <br />receipt / JOY79 <br />