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CITY OF MOUNDS VIEW <br />PLANNING APPLICATION <br />APPLICANT: Name <br />Interest in Property (Check Appropriate Blank): <br />nano �j -- g• - F 8 , <br />�S-1S80 <br />_ Owner of Record _ Lessee, Operator, Manager <br />Contractor for Deed Owner _ Agreement to Purchase <br />Other (Explain) Q,lyt 1 cT� nor e1& s,. d <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 Location ;9aQLc I—n'.-s �r , Mou",\5 %J%ew, M47"Y <br />SSllt <br />Legal Owner: Name/Address p n rTk J A rw, c-f <br />Present Use (Check Appropriate Blank): <br />Undeveloped/Vacant Apartment <br />Single Family Dwelling _ Business Esabl ishment <br />_ Duplex Dwell my _ Industrial Establ ishment <br />_ Multiple Dwell iny (3-6 units) <br />Other (expl ain) <br />Property Classification: Abstract Torrens <br />REQUEST: (Expl a <br />I hereby declare that the above statements are true. <br />signature <br />---------------------------------------------- <br />---------------------------------------- <br />FOR OFFICE USE ONLY: <br />BASE *(Base Fees are Non -Refundable) <br />FEES <br />TOTAL <br />DEPOSIT <br />Subdivision, Major <br />$250 <br />($150) <br />Subdivision, Minor <br />$IUO <br />(S75) <br />Rezoning <br />$100 <br />(S50) <br />Conditional Use <br />$100 <br />(550) <br />Variance <br />$75 <br />($5U) <br />Code Appeal <br />$100 <br />(550) <br />Alteration Permit <br />$150 <br />($50) <br />Plan Review <br />$100 <br />($50) <br />Other <br />(550) <br />PLANNING SIGN <br />$ 50 <br />TOTAL FEES PAID IUD <br />Date Paid ry 8 —9h <br />Receipt Number 33/faQ <br />Park Fund Dedication <br />Date Paid <br />Receipt Number <br />Addt'l Fees Paid <br />Date Paid <br />Receipt Number <br />