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APPLICANT: <br />CITY OF MOUNDS VIEW <br />PLANNING APPLICATION <br />Interest in Property (Check Appropriate Blank): <br />Date 47 P i <br />Phone 7y 533 <br />Owner of Record _ Lessee, Operator, Manager <br />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 thisrequesst. <br />PROPERTY: Address/General Location '? Q 7`/! <br />9 (3 i?LaYti�d b y <br />Legal Owner: Name/Andress 4 C-� "tee <br />Present Use (Check Appropriate Blank). <br />Undeveloped/Vacant _ Apartment <br />Singl a Famil y Dwell ing _ Business Esabl ishment • <br />_ Duplex Dwelling _ Industrial Establishment <br />_ Mul tipl a Dwell my (3-6 units) <br />Other (explain) <br />Property Classification: Abstract , Torrens <br />REQUEST: (Explain) N/A Cf <br />I hereby aecl are that the above statements are true. <br />------------------------------------------------------------------------ <br />FOR OFFICE USE ONLY: f bl ) <br />TOTAL <br />DEPOSIT <br />Subdivision, Major <br />S1U05 <br />($150) <br />(575) ia3- <br />Subdivision, Minor <br />51U0 <br />(550) <br />Rezoning <br />Conditional Use <br />$100 <br />_ <br />(S50) <br />Variance <br />Code Appeal <br />$75 <br />5100 <br />(S50) <br />($5U) <br />Alteration Permit <br />S15U <br />($5U) <br />Plan Review <br />s1UU <br />($50) <br />Uther <br />(S5U) <br />BASE *(Base Fees are Non -Re unaa e <br />FEES <br />TOTAL FEES PAID /oa 0e� <br />Date Paid 05" o ff9 <br />Receipt Number _0_,I 6 1 <br />Park Fund Dedication <br />Date Paid <br />Receipt Number <br />Aadt'l Fees Paid <br />Date Paid <br />Receipt Number <br />