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— � � <br />�i�'') � <br />�.�� <br />COMIVIUNITY DEVELOPMENT <br />2660 Civic Center Drive ❖ Roseville, N[N 55113 <br />Phone: (651) 792-7005 : Fax: (6� 1) 792-7070 <br />SETBACK PERMIT APPLICATION <br />CITY CODE SECTION 1013.05 <br />www.ci.roseville.mn.us <br />❑ APPLICATION FEE: $75 <br />����od� <br />APR 2 � 2008 <br />(Fee should be made payable to City of Roseville zrpon stibmittal of completed application.) <br />Please complete the application by typin� or printing in ink. Use additional paper if necessary. <br />1. Property Owner Information: <br />Last name: +�(,(3�� �� First name: ��— <br />Adclress: � 6�,� QI �(s�l,`k,bJ� I� • S. Ciry/State/Zip:. (LoS�-1/I�E� MIV ss� f 3 <br />Phone number: �,�( —%�%% �3(� (� Enzail address: �/( h� � �j�r� � G � �� �l, <br />2. Applicant Information: (if different from above) <br />Last name: <br />Adc�ress: <br />Phone number: <br />First name: <br />City/State/Zip: <br />Email address: <br />3. Statement of Intent: Briefly describe what will be done on the property requiring the Setback <br />Permit. <br />r i��l.c� i t� I �n�t.�a_� �-�.��� ,S�! ��- i r"� ��a � oY ?li-� �Z �-► <br />4. Additional Required Information: �se� � <br />a. Proposed Plans: A scaled site plan showing the eYisting and proposed building footprints as <br />well as driveways, sidewalks, and patios is required. Simple elevation drawings showing the <br />proposed addition or new building will also be required if the Setback Permit request doesn't <br />apply exclusively to a driveway. The plans for may be on 8%z"x 11" or 11 "x 17" paper. <br />b. Written Narrative: The written narrative should address the 12 criteria that must be considered <br />during review of Setback Permit applications; these criteria are listed in the document attached to <br />this application and in §1013.05 of the City Code. <br />5. Signature(s): By signing below, you attest that the information above and attached is true and <br />correct to the best of your knowledge. <br />nn 9� �I <br />Property Owner: l �' `.s�' �J�U � "' %�j� <br />� <br />Applicant: �� �� � '" � <br />Date: � Z'L—U� <br />Date: <br />�� <br />