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r. ��'� �Jl1��C�� ' � �. _ ��, COMMUNITY DEVELOPMENT 2660 Civic Center Drive : Roseville, MN 55113 Phone:(651)792-7005 :• Fax:(651)792-7070 ... SETBACK PERMIT APPLICATION CITY CODE SECTION 1013.05 www.ci.roseville.mn.us ❑ APPLICATION FEE: $75 pC�C��2�dC� � JUN 1'� 20Q8 (Fee should be made payable to City of Rosevil/e upon submittal of completed application.) Please complete the application by typing or printing in ink. Use additional paper if necessary. 1. Property Owner Information: c �, n Last name: .� T�-,�_ �,,,,., � First name: �� _ � , J v Address: //Y7 � ��v1� s �i`� L�. Ciry/State/Zip: �S � v-"/L�; /lf��i_ �� j' Phone number: �� S,( y�I �-c':� /`� Email address: 2. Applicant Information: (if different from above) Last name: ��:,,. � First name: Address: Ciry/State/Zip: Phone number: Email address: 3. Statement of Intent: Briefly describe what will be done on the property requiring the Setback Permit. 4. Additional Required Information: a. Proposed Plans: A scaled site plan showing the existing and proposed building footprints as well as driveways, sidewalks, and patios is required. Simple elevation drawings showing the proposed addition or new building will also be required if the Setback Permit request doesn't apply exclusively to a driveway. The plans for may be on 8'/2"x 11" ar 11 "x l 7" paper. b. Written Narrative: The written narrative should address the 12 criteria that must be considered during review of Setback Permit applications; these criteria are listed in the document attached to this application and in § 1013.05 of the City Code. 5. Signature(s): By signing below, you attest that the information above and attached is true and correct to the best of your knowledge. , � .� � Property Owner: � _ 1 Date: G / s Applicant: ,�., f.,,, c_ Date: �