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CITY OF MOUNDS VIEW <br />PLANNING APPLICATION <br />APPLICANT: Name DUf}�t%F J l�FfkE2 <br />Addrpss <br />Interest in Property (Check Appropriate Blank): <br />YOwner of Record <br />_ Contractor for Deed Owner <br />Other (Explain) <br />Date S—o1 y-90 <br />Phone <br />Lessee, Operator, Manager <br />_ Agreement to Purchase <br />Documentary evidence of appl icant's interest in the property may be required <br />before final City action on this request. rr !� I <br />PROPERTY: Address/General Location ''3/0 `kkW0od KUcIQ <br />Legal Owner: Name/Address A.>U/}'VE r � KA-4156W K, 8F7 Ep- <br />Present Use (Check Appropriate Blank): <br />Undeveloped/Vacant <br />_ Apartment <br />Single Family Dwelling <br />_ Business Esablishment <br />Duplex Dwell my <br />_ Industrial Establishment <br />_ <br />Mul tipl a Dwell my (3-6 units) <br />_ <br />Other (explain) <br />Property Classification: Abstract <br />Torrens <br />REQUEST: (Explain) 94A, d 0-1 Il ao � 4 sc-464V pw2 <br />I hereby declare that the above statements are true. LY <br />�Cf�t�y�ature <br />------------------------------------------------------------------------------------- <br />FOR OFFICE USE ONLY: <br />TOTAL BASE *(Base Fees are <br />Non -Refundable) <br />DEPOSIT FEES <br />Subdivision, Major $250 ($150) <br />TOTAL FEES PAID 1 62 03o <br />Subdivision, Minor $IUO (S75) <br />$100 (S50) <br />Date Paid 'mr-a-9-Io <br />Receipt Number 7i3 aS <br />Rezoning <br />Conditional Use $100 (S50) <br />Variance $75 (S50) <br />Code Appeal $100 (S50) <br />park Fund Dedication <br />Alteration Permit $150 (S50) i S n <br />Date Paid <br />n Review $100 ($50) <br />Receipt Number <br />Owner (S50) <br />$ 50 <br />Addt'1 Fees Paid <br />PLMPJiNG SIGN <br />Date Paid <br />Receipt Number <br />