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� <br />C� <br />��.���E��� � <br />� D <br />COMMUNITY DEV�LOPMENT <br />�660 Civic Center Drive ❖ Roseville, MN 55113 <br />Phoi�e: (651) 79Z-7605 •'r Fa�:: {65 I) 792-7070 <br />PRELIMINARY PLAT APPLICATION <br />C1TY COD6 SC-CTION 1 tOZ <br />www.ci.roseville,mn. us <br />❑ APPLICATION F�E: $500 <br />❑ ESCROW D�POSIT: $1,540 <br />EIVE <br />JlJN 18 2009 <br />(rlpplicatiora,fee a�rd escrotin deposil shonld be made poyable to Ciry� of Roseville uporr aubnrilfal of cou:pleted app/rcario�T <br />Escrou�.%rrnds �ril! be drmrrr to corer project-related costs Addilia�al fretids nray be required, surplus frrnds 1��r11 be relrrrned ) <br />Please complete the application by typing ar printing in ink, Use additional paper if necessary. <br />1. Property O�vner Information: <br />Company �7ante: (..3'Fi1 '{' <br />Last ��ame �t,� _ First r�nme : �'�C <br />Add��ess ��"� �� 'i��vp � Su $y�'rry�S1QlL'�Zl jJ.'�"I�7L� J`ll'`� �.�`f 31 <br />Phone �Trnnbe�° �. �_ �Z.S Email addre,ss �Au�� � _ eot-t <br />2. Applicant Information: ('rfc�iffel�ent fi•onr above) <br />Conapa�ay r�a�r�e: <br />I,ast name. <br />Address: <br />Pho�7e ��umber: <br />Frrst rtcrnre. <br />City/State/Zip: <br />Email address. <br />3. Address(es) of Pro�erty invo[ved: (if differer7t fi•onr abo��e) <br />`�Og'��1/> �VC� �. ��.L�, t'lr� '.SSlI� <br />4. Zoning Designation:�i.�`p <br />5. Comprehensive Plan Designation: <br />C� <br />Statement of Intent: Describe the properties to be con�bined or created as a part of this Pre(iminary <br />Plat application and indicate whether a variance, zoning change, and/or Conditional Use Pertnit will <br />be required for tl�e proposed parcels or the intended use. <br />Preliminary Plat Application Page 1 of 2 <br />