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CITY OF MOUNDS VIEW o <br />PLANNINGAPPLICATION <br />Date <br />AI�PLICANT: Name �AIJ'��y f RuCL Phone <br />meLICANT: Name <br />Address 23;2 "��n1A'OO17 IZn — <br />Interest in Property (Check Appropriate Blank): <br />X Owner of Record Lessee, Operator, Manager <br />Y Contractor for Deed Owner _ Agreement to Purchase <br />—Other (Explain)_,_, <br />Documentary evidence of applicant's interest in the property may be required <br />before final City action on this request. <br />PROPERTY: Address/General Locaticn SA Ml' ftS /�BOUE <br />Legal Owner: Name/Address SAME q 5 rrBO U �' <br />Present Use (Check Appropriate Blank): <br />Undeveloped/Vacant Apartment <br />Single Family Dwelling _ Business Esablishment <br />_ Duplex Dwell ing _ Industrial Establ ishment <br />Mul tipl a Dwell ing (3-6 units) <br />Other (explain) <br />Property Classification: Abstract Torrens <br />REQUEST: <br />I hereby declare that the above statements are true. v ure� <br />---------------------------------------------------------------- <br />FOR OFFICE USE ONLY: <br />TOTAL BASE *(Base Fees are Non -Refundable) <br />DEPOSIT FEES <br />Subdivision, Major $25U ($15U) TOTAL FEES PAID /so .a-V <br />Subdivision, Minor $IUD ($15) Date Paid J <br />Rezoning sluo (S50) Receipt Number <br />Conditional Use S1UO ($50) <br />Variance $75 ($5U) Park Fund Dedication <br />Code Appeal Ap (S50) —° pate Paid <br />-'+O 1 ' teration Permit 315U ($5U) Receipt Number <br />!an Review u (S50) <br />Uther. ($5U) <br />ptldt'1 Fees Paid <br />Dat= Pa'o <br />Receipt NnmDer <br />