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PLANNING APPLICATION <br />Date <br />APPLICANT: <br />name � /�V11ins Levee y-r_s phone <br />address n ZGo % Cep. /2,4, IS <br />Interest In property (check appropriate box): <br />owner of record ❑ lessee, operator, manager <br />❑ contract for deed owner ❑ agreem^nt to purchase <br />❑ other (explain) <br />Documentary evidence of applicants interest In the property may be <br />required before final city action on this rrquest. <br />PROPERTY: address/general.locatlon <br />legai owner: name/address SQ_7Is 1)5 A ,/✓ � <br />present use (check appropriate box): <br />❑ undeveloped ❑ business establishment <br />!Y single family dwelling ❑ Industrial establishment <br />❑ duplex dwelling ❑ apartments <br />❑ other (explain) <br />kFQUEST: (explain) MIA, <br />I hereby declare that the above statements are truu <br />FOR OFFICE. USE ONLY: <br />BASE FEES* <br />subdivision, major <br />($150) <br />subdivision, minor <br />($75) <br />rezoning <br />(550) <br />conditional use <br />($50) <br />variance <br />_ <br />($5O) <br />code appeal <br />($50) <br />subtutaI <br />*Base fees in parenthuSis are non- <br />refundable. <br />Park fund dedication <br />date pald <br />receipt # <br />ADDITIONAL FEES <br />:capportionment <br />public hearing notices _ <br />stalf, consultant reviews /p <br />miscellaneous <br />subtotal <br />TOTALFEES <br />date paid p_ <br />receipt p /,go0�/ <br />