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CITY OF MOUNDS VLEB <br />PLANNING APPLICATION <br />Date /-,!D/-ir . <br />APPLICANT: Name,-�/4/4-" j �—y� Phone <br />Addeesa n J 7 S <br />Intereat,in Ptopetty (check apptopriate box), <br />Owner of Record Lessee, Operator, Manager <br />Conttatiot for Deed Owner 8 Agreement to Purchase <br />other (Expinin) <br />Documentary evidence of applicant's interest ir, the property may be required <br />before filial City action on this request. <br />, <br />PROPERTY! Addresa/Genetal LocAtlon�J r_L�'P.rlel:2�,o,e�� <br />Legal Gwuet! <br />Present Use (Check Appropriate Box): <br />llndeveloped Nacant Apartment <br />SinA10 Pamilv Dwelling Business Eanblishment <br />Duplex Dwelling fl Industrial Establishment <br />Multiple Dwelling (3-6 units) <br />Other (explain) _ <br />P;operl; Classification! ❑ AbstrAct AD-Torrens <br />REQUEST! <br />I hereby declare that the Above stotements are true.(signature) <br />FOR FOR OFFICE USE ONLY: <br />BASE FEES* ADDITIONAL FEES <br />Subdivision, Mnjot ($150) Reapportionment <br />Subdivinion, Minor ($75) Public hearing Notice <br />Rezoning ($50) —aff, Consultant Reviews IOO-o U_ <br />Conditional Use ($50) _r o �' Miscellaneous <br />Variance ($.t01 <br />Code AppeAl ($50) _ <br />Alteration Permit ($50) _ <br />*Rase Fees In pArenthesis Are.. non-refundable. <br />Subtotal <br />Park Fund Dedication TOTAL FEES <br />Date. Paid Date Paid <br />Receipt Number __ Rereipt Number 011,3,5 <br />