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CITY OF MOUNDS VIEW <br />PLANNING APPLIICAATTION <br />P�CANT: Name ve�4Pv u N 14 l 1 Date <br />( Phonelf q,5e4o <br />Address Sd <br />Interest in Property (Check Appropriate Blank): <br />Owner of Record <br />— Contractor for Deed Owner — Lessee, Operator, Manager <br />— Other (Explain) — Agreement to Purchase <br />:OPERTY: <br />Documentary evidence of applicant's interest in the property may be required <br />before final City action on this request. <br />Present Use (Check Appropriate Bl ank): <br />Undevelopea/Vacant <br />Singl e Family Dwell l ing — Apartment <br />— Duplex Dwelling _ Business Esablishment <br />— Multiple Dwelling (3-6 units) — Industrial Establishment <br />— Other (explain) <br />Property Classification: C rt <br />orrens <br />_WEST: <br />(Expl din <br />hereby aecl are that the above statements are true. <br />sign lure <br />- <br />:JR OFFICE USE ONLY: <br />---------------------------------------- <br />TOTAL BASE *(Base Fees are Non -Refundable) <br />DEPOSIT FEES <br />Subdivision, Major S25U (5150) <br />Subdivision, Minor Rezoning ,S1OO S•1U0 ((150 S �a TOTAL FEES PAID )Oo.d(, <br />Date Paia _ <br />Conditional Use S5U Receipt Plumber <br />Variance S 75 (S5U) <br />(S5U}• <br />Code Appeal $100 <br />Alteration Permit (S5U Park Puna Dedication S15U <br />-Wn Review (550) Date Paid <br />�L�er SIUU P Receipt Plumber <br />(550) <br />Aaat'l Fees ?aid <br />Data Paid <br />Raceidt Number <br />