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'md 76 <br />CITY OF MOUNDS VIEW <br />Q ///PLANNING APPLICATTION Date <br />Phone_ <br />®APPLICANT: <br />Address 6-/ <br />in <br />PROPERTY: <br />REQUEST: <br />Interest in Property (check appropriate box): <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 />befure final City action on this request. <br />Address/General Location <br />c� J <br />Legal Owner: Name/Address 1 <br />Present Use (Chock Appropriate Box): <br />Apartment <br />Undeveloped/Vacant Business Esablishment <br />Single Family Duelling Industrial Establishment <br />Duplex Dwelling <br />Multiple Dwelling (3-6 units) <br />Other (explain) <br />Property Classification: <br />❑ Abstract ❑ Torrens <br />I hereby declare that the above statements are true. Sgnature) <br />FOR OFFICE USE ONLY: <br />BASE FEES* <br />Subdivision, Major <br />Subdivision, Minor <br />Rezoning <br />Conditional Use <br />Variance <br />Code Appeal <br />Alteration Permit <br />ADDITIONAL FEES <br />($150) <br />Reapportionment <br />(j75) <br />Public Ilearting Notices � <br />($50) <br />Staff, Consultant Reviews //rfSA L <br />, <br />($50)pO�— <br />Miscellaneous <br />($50) _ <br />($50) _ <br />($50) <br />l *Base Fees in parenthesis are non —refundable - <br />Park Fund Dedication <br />Date Paid <br />Receipt Number ___-- <br />Subtotal <br />'DOTAL FEES <br />Date Paid <br />Recelpt Number <br />