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CITY OF MOUNDS VIEW _ <br />PLANNING APPLICATION <br />Date `I <br />APPLICANT: Name •✓0//^J �ORS�E _ PhoneSYi-%%�� i <br />Interest In Property (check appropriate box): <br />Owner of Record Lessee, Operator, Manager <br />Contractor for Deed Owner 8 Agreement to Purchase <br />other (Explain) _ <br />Documentary ev',dence of applicant'a Interest In the property may he required <br />before final City aetion on t'�h"�i��s request. <br />PROPERTY: Addreae/General Location .S/r/r Zian,11P LOatfr A5,, J A00 GD/."ALS59. <br />--�di•RTNB','FB---- <br />Legal Owner: Name/Address Syrt .f?i fro.it <br />REQUEST: <br />Present Use (Check Appropriate Box): <br />Undeveloped/Vaennt <br />Single Family Dwelling <br />Duplex Duelling <br />Multiple Dwelling (3-6 units) <br />Other (explain) <br />Apartment <br />Business Eaablfahment <br />Industrial Establishment <br />Property Classificationt L1 Abstract [3 Torrents K 4%c1JA11kW <br />(Explain) syfrtnwo iONt✓L MAP 41^7r4rv#7o+l.&: <br />I hereby declare that the above statements are true. <br />(signature) <br />FOR OFFICF, USE ONLY: <br />BASE FEES" ADDITIONAL FEES <br />Subdivision, Major ($150) Reapportionment <br />Subdivision, Minor ($15) Puhllc Israrting Nnticea <br />Rezoning ($50) _ Staff, Consultant Reviews 2 S D <br />Conditional Use ($50) Miscellaneous <br />Variance ($50) <br />Code Appeal ($50) $17 <br />Alteration Permit ($50) <br />f Rane Feen in parenthesis are non-refundable. <br />� 1 <br />Park Fund Dedication <br />Date Paid <br />Receipt Number <br />Snhtntal <br />TOTAL FEES <br />Date Paid <br />Receipt Number <br />13 <br />