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--�. <br />..,. <br />jJ� <br />� <br />COMMUNITY DEVELOPMENT <br />2660 Civic Center Drive •3 Roseville, MN 55113 <br />Phone: (651) 792-7005 ❖ Fax: (651) 792-7070 <br />SETBACK PERMIT APPLICATION <br />CITY CODE SECTION 1013.05 <br />www.ci.roseville.mn.us <br />❑ APPLICATION FEE: $75 <br />�C�C��Od� <br />JUN i, � C008 <br />(Fee should be made payable to Cil�� of Roseville upon submittal of completed application.) <br />Please complete the application by typing or printing in ink. Use additional paper if necessary. <br />1. Property Owner Information: <br />Last name: �� iT� <br />First name: �U I3�' <br />Address: �°4(���/1-rp1,�Nt7�-i�l,l� Ce[� City/State/Zip: �O�EUIU�� MN. <br />Phone number: (o51-lv3�-O°{8� Email address: <br />2. Applicant Information: ('rf different from above) �yv�c�'� �I�.�'►�-�,�..�'�. <br />Last name: M ls�o�/.t�G First name: Cofzy. <br />Address: 4'140 42�,�•N � City/State/Zip: ��G7�l.E MN• 5�22 <br />Phone number: �<03-533-0352 Email address: co�-yrvtiskaNi���w1ro►�5e �,co�n.� <br />� <br />3. Statement of Intent: Briefly describe what will be done on the property requiring the Setback <br />Permit. <br />�.P� fS�w�.�E $1,�,) J�R� ca��f'Rt�11N6 ,�r 8'- wtGE X� � t�'arT' FRc�M t�eus�� <br />C:aJ�t� i'd�Tt � qJ (2) Fb3[� v.f/ p+ 22' tcq-� ��' P�vw �F oJ� 6�6� <br />� IS �-�� � l�n pwP I��on� fi�n�Tpa <br />kND C-�� A�I�, WI��GW l�pS �N a �k�- �1'�Vt,EM �-1,y Gtrrt�7 <br />4. Additional Required Information: <br />a. Proposed Plans: A scaled site plan showing the existing 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'/2"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 />Property Owner.• <br />� (/1/ % �"`��� �- r <br />Applicant: � ��^ <br />Date: <br />Date: �j(�• ��. 2G��j • <br />