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CITY OF MOUNDS VIEW <br />PLANNING APPLICATION pates 9 <br />P�CANT: Name /%J/L'ff i`E! fl4ul$ Phone 7 <br />Address 76 G�01/E'4,410 iQD <br />Interest in Property (Check Appropriate Blank): <br />Owner of Record _ Lessee, Operator, Manager <br />_ Contractor for Deed Owner _ Agreement to Purchase <br />Other (Expl ain) <br />Documentary evidence of applicant's interest in the property may be required <br />before final City action on this request. <br />JROPERTY: Address/General Location S M9' --- <br />Legal owner: Name/Acores s__22rjag Lake Park Knot ^ North 7S fAet <br />of Lot 18 <br />Present Use (Check Appropriate Blank): <br />Undavelopea/Vacant _ Apartment <br />Sing] P Famil y Dwell my Business Esabl ishment <br />_ Oupl ex Dwell ing _ Industrial Establ ishment <br />_ Multiple Dwell iny (3-5 units) <br />Other (expl ain)____ <br />Property Classification: Abstract Torrens <br />REQUEST: (Explain)., A".0 <br />I hereby aecl are that the above statements are true. " <br />--ynature^ <br />-------------------- <br />FVR UFFiCE USE ONLY: <br />Subdivision, Major <br />Subdivision, Minor <br />Rezoning <br />Conditional Use <br />Variance <br />Code Appeal <br />11teration Permit <br />(.,an Review <br />Utner <br />TOTAL <br />DEPOSIT <br />S25U <br />S1U0 <br />S <br />IUO <br />175 <br />S10o <br />s15u <br />S1UU <br />(5150) <br />($15) <br />(550) <br />(550) <br />(55U) <br />(S5U) <br />($5u) <br />050) <br />(S5U) <br />BASE *(Bass Fees are Non-Refunaabl e) <br />FEES <br />TOTAL FEES PAID 4`/oD•� <br />Date Paid <br />Receipt Number 3ei8^7 <br />Park Fund Dedication <br />Date Pala <br />Receipt Number <br />Acat'i Fees ?aid <br />'a.e Rua <br />Receidz Numoer <br />